Overlap syndrome and collagenous sprue: another cause of diarrhoea.

Case report


Fathi O. Dakhil 1, Fiona M. Stevens 2.

1-Department of Medicine, Arab Medical Sciences University, Benghazi, Libya, 2-Department of Medicine, National Uni¬versity of Ireland, Galway.

Libyan J Infect Dis. Vol. 2, No.1. Jan-2008:57-59


In a 60-year-old female patient with features of an overlap syndrome, jejunal biopsy specimens showed typical findings of coeliac disease with marked increase in subepithelial collagen band (CB) thickness. This has been confirmed by staining with van Gieson (VG), and examination of H&E sections by fluorescence microscopy. Immunohistochemical staining revealed that there is a subepithelial accumulation of tenascin. In scleroderma, hypomotility of the small intestine produces symptoms of malabsorption due to bacterial overgrowth in the dilated intestine. In this patient the development of subepithelial CB might have contributed to the development of malabsorption. Examination of H&E section with fluorescence microscope had the advantage of a quicker and more precise measurement of the thickness of the subepithelial collagen deposits than the routinely performed H&E or VG staining. Immunodetection of tenascin, which appears as a selective subepithelial accumulation, is also a reliable diagnostic tool. The association of overlap syndromes and collagenous sprue has not been reported before. This appears to be the first recorded occurrence of such findings.

Keywords: Bacterial overgrowth, coeliac disease, collagenous sprue, diarrhoeal diseases, overlap syndrome.

Link/DOI: http://www.nidcc.org.ly/reports/THE%20LIBYAN%20JOURNAL%20OF%20%20Infectious%20Diseases%20V2%20%20No%201/9%20Overlap%20Syndrome%20and%20Collagenous%20Sprue.pdf