Collagenous Enteritis – An Alternative Cause of Malabsorptive Enteropathy

Abstract

Introduction: Collagenous Enteritis (CE) is a less common cause of enteropathy presenting with malabsorption as its cardinal symptom. While historically considered a resistant form of celiac disease, newer evidence supports the interaction between genetic predispositions and environmental triggers as the pathophysiologic basis of CE. Case Presentation: Herein we present the case of a 40-year-old woman with two-year history of diarrhea and 32 kg weight loss who was incorrectly diagnosed with celiac disease with refractory symptoms despite adherence to a gluten-free diet. Extensive infectious, inflammatory, secretory, autoimmune workup did not reveal an underlying etiology. Endoscopic evidence of severe villous blunting and biopsy with characteristic patchy enlarged subepithelial collagen layer solidified a diagnosis of CE. Treatment with steroids resulted in resolution of malabsorptive symptoms and gradual weight gain. Conclusion: This case highlights the importance of considering CE in patients presenting with malabsorption especially given significant clinical overlap with other malasbsorptive conditions as well as its therapeutic implications.