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Two coincident cases of easily curable ‘refractory sprue’
  1. Dietmar Schiller1,
  2. Alexander Ziachehabi1,
  3. Rene Silye2,
  4. Rainer Schöfl1
  1. 1Department of Internal Medicine IV, Elisabethinen Hospital, Linz, Austria
  2. 2Institute of Clinical Pathology, Linz General Hospital, Linz, Austria
  1. Correspondence to Dr Dietmar Schiller, Department of Internal Medicine IV, Elisabethinen Hospital, Fadingerstr. 1, Linz 4020, Austria; dietmar.schiller{at}elisabethinen.or.at

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Clinical presentation

On two consecutive days, two women, 82 and 76 years of age, were admitted with severe watery diarrhoea lasting for about 8 months. They presented with serious deconditioning and a weight loss of 16 and 20 kg, respectively. An extensive workup had yielded virtually identical results in both patients and led to the diagnosis of ‘refractory seronegative sprue’. There was no history of foreign travel or previous GI symptoms. Duodenal biopsy showed subtotal villous atrophy (VA) (figure 1) with an increased number of intraepithelial lymphocytes (figure 2). IgA and IgG tissue transglutaminase and endomysial antibodies, serum immunoglobulins, HIV serology, T-cell receptor rearrangement …

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