A 20-year-old female sees her physician for diarrhea and fatigue with a 20 pound weight loss over the past 6 months. On exam, she is afebrile and has mild muscle wasting, but her strength is normal. Stool studies do not reveal blood, ova, or parasites. A biopsy of the jejunum is taken and microscopically reviewed. The patient is placed on a special diet with no wheat or rye products. The change in diet produces a dramatic improvement. Which of the following microscopic features is most likely to be seen in the biopsy?
Crypt abscesses
Foamy macrophages within the lamina propria
Lymphatic obstruction
Noncaseating granulomas
Villous blunting and flattening
Correct answer
Villous blunting and flattening
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correct answer: E
This patient has malabsorption that responded to dietary treatment; likely celiac disease (gluten sensitivity). The histological features of celiac disease are flattening of the mucosa, diffuse and severe atrophy of the villi, and chronic inflammation of the lamina propria.
Crypt abscesses (choice A) is incorrect; these are nonspecific and can be seen in inflammatory bowel disease.
Foamy macrophages (choice B) and lymphatic obstruction (choice C) are incorrect; these features are seen in Whipple’s disease. PAS-positive granules can show Tropheryma whippelii under electron microscope.
Noncaseating granulomas (choice D) is incorrect; these are found in Crohn’s disease