Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with persistent or recurrent malabsorptive symptoms (chronic diarrhea, weight loss, abdominal pain) despite strict adherence to a gluten-free diet (GFD) for >12 months. Evaluation confirms persistent villous atrophy and aberrant intraepithelial lymphocyte (IEL) phenotype (CD3+, CD8-, CD4-, TCR-gamma/delta negative) consistent with Type II RCD. No evidence of dietary non-compliance or alternative malabsorptive etiology.
Clinical Examination Findings
General: Patient appears chronically ill, cachectic, or malnourished. Abdomen: Soft, non-distended, mild generalized tenderness, no palpable masses or organomegaly. Skin: Pallor, signs of vitamin deficiencies (e.g., glossitis, cheilosis, or petechiae). Neurological: No focal deficits; assess for peripheral neuropathy or ataxia. Lymphatic: No palpable peripheral lymphadenopathy.
Treatment Protocol
Initiate nutritional optimization (parenteral/enteral support if indicated). Pharmacotherapy: Budesonide (9 mg/day) or systemic corticosteroids as first-line induction. Consider immunosuppressive therapy (e.g., Azathioprine, Cyclosporine, or Infliximab) for refractory cases. Close monitoring for progression to Enteropathy-Associated T-cell Lymphoma (EATL) via repeat endoscopy/biopsy and PET-CT if clinically indicated.