An 84-year-old male with hypertension and chronic hepatitis B treated with tenofovir.
She reported a 9-month history of watery, diurnal and nocturnal diarrhea, without pathological products, accompanied by loss of 23 kg of weight.
He had no fever, nausea, vomiting, abdominal pain or other symptoms.
Physical examination revealed only one malnourished aspect with a body mass index of 18.3 kg/m2.
Analytically, the only relevant alterations were hypocholesterolemia (75 mg/dl), decrease in total proteins (4.7 g/dl) with normal proteinogram and INR of 1.3.
Renal function, hepatic profile, thyroid hormones, series, vitamin B12, folic acid, ferritin, C-reactive protein, immunoglobulins and antitransglutaminase IgA antibodies were normal.
HLA-II typing showed absence of alleles associated with celiac disease.
The microbiological study of stools (coprocultive, Cl. difficile toxin and fresh stool examination) was negative.
D-xylosa test and fat quantification in faeces were pathological (2.68 g in urine 5 h and 16 g in faeces 24 h, respectively).
Barium transit was performed, observing contrast flocculation at jejunal level.
Upper gastrointestinal endoscopy showed an atrophic duodenal mucosa with a quartz aspect, and the loop was normal.
Duodenal biopsies showed non-contrast desaturated desaturation and epithelial denudation, with superficial fibrosis in the band and around the capillary vessels and lymphoplasmacytic increase in the lamina propria.
The immunophenotypic study of intestinal biopsies was not suggestive of CDe (percentage of intraepithelial lymphocytes - ILE - not increased, percentage of TCR lymphocytes δ compared to total epithelium of LIE -10 not increased).
Although the association between CD and collagenous colitis has been described, colon biopsies were normal.
The study was completed with an endoscopic capsule examination, which confirmed the presence of a mosaic-painful white deposit of the duodenal and jejunal mucosa.
This led to the diagnosis of CD and the patient started a gluten-free diet (DSG), with improvement of the diarrheic condition and initial gain of 5 kg of weight, but with recurrence of hepatitis b recurrence and persistence of
