Increase in gamma/delta T cell receptor bearing lymphocytes in normal small bowel mucosa in latent coeliac disease

Celiac disease is an intestinal malabsorption syndrome characterized by intestinal bleeding, diarrhea, malnutrition, and disordered calcium metabolism. This condition is caused, at least in part, by a hypersensitivity to dietary gluten (a protein found in wheat). Celiac disease has been reported to have a higher prevalence and to occur in a latent form in patients with herpetiform dermatitis (an inflammatory disease of the skin); both of these conditions have been linked to disorders of the immune system. It has been reported that increased levels of a particular subclass of immune cell (T lymphocytes which express the gamma/delta receptor molecule) may be a diagnostic marker for the presence of both latent and overt celiac disease. A case (the first such documented case) is described of a 35-year-old man who was studied because of an abnormality in blood chemistry (low serum titer of reticulin antibody) and because of the presence of overt celiac disease in his son. (The patient had been diagnosed with epilepsy, and suffered infrequent seizures; this was not thought to be related to the variables assessed in this case.) Intestinal biopsy revealed completely normal anatomy of the small intestine, and celiac disease would have been ruled out on this basis alone. Total lymphocyte level was normal in the biopsy specimen, but the number of cells expressing the gamma/delta T cell receptor was 10 times that found in normal subjects. Two years later, a subsequent intestinal biopsy specimen was taken because of celiac disease symptom onset; microscopic anatomy was consistent with a diagnosis of celiac disease. A biopsy taken during a period in which the patient was on a gluten-free diet showed normal intestinal anatomy, but continued elevation of gamma/delta T cell receptor-positive lymphocytes. (Consumer Summary produced by Reliance Medical Information, Inc.)