Wayne State University School of Medicine Detroit, MI, United States
Katelyn A. Kerr, BS1, Nirmal Kaur, MD2, Syed-Mohammed Jafri, MD3 1Wayne State University School of Medicine, Detroit, MI; 2Henry Ford Health System, Novi, MI; 3Henry Ford Health System, Detroit, MI
Introduction: Autoimmune enteropathy is a rare and severe condition where the body mounts an immune response against enterocytes, goblet cells, and mucin.1 Diagnosis is typically made using a multifaceted approach via the synthesis of findings from endoscopy, histology, serology and clinical symptoms.2 Diagnosis can be difficult as many of the symptoms and findings can overlap with other gastrointestinal conditions such as ulcerative colitis.2 Colitis is usually only found in the colon; however, anti-enterocyte IgG antibodies associated with autoimmune enteropathy can affect both the small intestine and the colon.3 While autoimmune enteropathy and ulcerative colitis share some characteristics such as significant diarrhea, gastrointestinal distress and malfunction as well as immune dysregulation, the link between autoimmune enteropathy and ulcerative colitis remains unclear.
Case Description/Methods: We present a 30-year-old female with an 11 year history of ulcerative pancolitis. The patient showed no response to high dose Adalimumab Or Infliximab, and is suspected to be non-responsive to TNF-< ![if !msEquation] >< ![if !vml] >< ![endif] >< ![endif] > therapy. In Fall 2020, she was diagnosed with autoimmune enteropathy following hospitalization with symptoms related to ulcerative colitis as well as new onset nausea and vomiting. Esophagogastroduodenoscopy performed September 2020 showed mucosal changes including atrophy, granularity and scalloping. Biopsy showed villous atrophy, crypt hyperplasia, foveolar metaplasia, increased crypt apoptosis and active duodenitis with erosion. Anti-enterocyte antibodies returned positive.
Discussion: The patient is currently in remission on tacrolimus, vedolizumab and oral prednisone. Typically, diarrhea is the main clinical symptom used to describe Autoimmune Enteropathy in the literature; whereas, our patient received her diagnosis after hospitalization due to severe vomiting and nausea. Like the patient described by Rodreguez, our patient's symptoms did not improve with use of intravenous steroids.4 This patient’s long standing inflammatory condition may have potentially played a role in the development of autoimmune enteropathy as chronic inflammation is a risk factor in the development of autoimmune disease.
Disclosures: Katelyn Kerr indicated no relevant financial relationships. Nirmal Kaur indicated no relevant financial relationships. Syed-Mohammed Jafri indicated no relevant financial relationships.
Katelyn A. Kerr, BS1, Nirmal Kaur, MD2, Syed-Mohammed Jafri, MD3. P1688 - Exploring the Interplay Between Autoimmune Enteropathy and Ulcerative Pancolitis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.