case_images: PMC8361549_01
case_images: Upper gastrointestinal tract and liver biopsy findings. (A) Villous atrophy in the duodenal biopsy. There is complete villous atrophy, crypt hyperplasia, intraepithelial lymphocytosis, and mixed chronic inflammatory cell infiltrate in the lamina. Hematoxylin and eosin (H&E) stain, x200. (B) Lymphocytic gastritis pattern. The gastric biopsy shows a significantly increased number of intraepithelial lymphocytes (arrows). No Helicobacter pylori are identified by special stain (not shown), H&E, x200. (C) Liver biopsy shows portal lymphocyte-predominant chronic inflammatory cell infiltrate, H&E, x200. (D) Focal aggregate of plasma cells (arrow), H&E, x400.
case_images: 10.1177_23247096211037463-fig1.jpg
case_images: PMC8361549_01_10.1177_23247096211037463-fig1.jpg
case_images: fig1-23247096211037463
case_images: Duodenal and gastric biopsy showed moderate to marked chronic duodenitis with the absence of villous architecture (intraepithelial lymphocytosis and villous atrophy) along with moderate chronic lymphocytic gastritis (intraepithelial lymphocytosis), with no Helicobacter pylori or amyloid identified, raising the possibility of malabsorption pattern such as celiac/SE (Figure 1A and B). No florid duct lesion or granuloma suggesting primary biliary cirrhosis (Figure 1C and D).