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A patient with agammaglobulinemia, malabsorption and a rheumatoid-like arthritis is described. The malabsorptive process is considered to be etiologically distinct from adult celiac disease because of the patient's failure to respond to a gluten-free diet. In addition, although the jejunal biopsy specimen showed absence of villi, the infiltration of inflammatory cells in the lamina propria was unusually dense and composed almost entirely of lymphocytes. An attempt to relate the malabsorption to small intestinal bacterial overgrowth or to the gamma globulin deficiency per se was unsuccessful. The serum decay and fecal loss of injected gamma globulin were measured. There was no evidence of increased catabolism or excessive fecal loss of gamma globulin. The similarities of this patient's arthritic process to rheumatoid disease are emphasized. Superimposed on the arthritis is a severe degree of osteomalacia caused in part by excessive endogenous fecal loss of calcium. The interrelationships of the various facets of this patient's disease are explained. The course of the malabsorption and arthritis could not be related to replacement therapy with gamma globulin or to other aspects of the disease process.