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Successful Treatment of Refractory Sprue with Cyclosporine

George F. Longstreth, MD
[+] Article and Author Information

From Southern California Permanente Medical Group, San Diego, California. Requests for Reprints: George F. Longstreth, MD, Kaiser Medical Center, 4647 Zion Avenue, San Diego, California 92120. Acknowledgment: The author thanks Dr. William Cory for substantial contributions to the patient's care, Dr. Naomi Buckwalter for pathology consultation and the photographs, Dr. Martin F. Kaghoff for DNA typing.


Copyright 2004 by the American College of Physicians


Ann Intern Med. 1993;119(10):1014-1016. doi:10.7326/0003-4819-119-10-199311150-00008
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Celiac sprue is a disorder of absorption that is identified by characteristic histologic abnormalities in the small-bowel mucosa [12]. The clinical and histologic features respond to a gluten-free diet. Patients with refractory sprue do not respond to strict gluten avoidance and have a poor prognosis [3]. A patient with severe sprue who was unresponsive to a gluten-free diet and corticosteroid therapy experienced remission after receiving cyclosporine therapy.

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Figure 1.
Duodenal biopsy findings in a patient with sprue.Panel APanel BPanel CPanel D

Initial biopsy specimen showing total villous atrophy, crypt hyperplasia, flattened surface cells, and an intense inflammatory infiltrate in the lamina propria. Goblet cells are absent. Biopsy specimen obtained after the patient had been on a gluten-free diet for 2.5 years, showing persistence of abnormalities typical of sprue. Biopsy specimen obtained after cyclosporine use for 1 year, showing villi with a villous:crypt ratio of 1:1, columnar surface cells, a normal number of goblet cells, and less inflammation. Biopsy specimen obtained 3 years after cyclosporine therapy was discontinued, showing no abnormality. The villous:crypt ratio is 3:1 (hematoxylin and eosin).

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