A 32-year-old woman is evaluated for a 6-month history of fatigue, loose stools, and an intensely pruritic, vesicular rash symmetrically distributed over her elbows and knees. Laboratory studies reveal a microcytic anemia, and serologic testing is markedly positive for anti-tissue transglutaminase IgA antibodies. The patient subsequently undergoes an esophagogastroduodenoscopy with biopsy of the distal duodenum, as well as a punch biopsy of perilesional skin. Which of the following histopathologic and immunofluorescence findings are most likely to be present in this patient's biopsy specimens? (Select all that apply)
- Crypt hyperplasia with villous blunting and intraepithelial lymphocytosisCevap
- BLinear IgG and C3 deposition along the basement membrane zone
- CTransmural lymphocytic infiltration with noncaseating granulomas
- Granular IgA deposition localized to the tips of the dermal papillaeCevap
- EThickened subepithelial collagen band in the lamina propria
Cevap
The correct biopsy findings are crypt hyperplasia with villous blunting and intraepithelial lymphocytosis in the duodenum, alongside granular IgA deposition localized to the tips of the dermal papillae in the skin.
The patient's clinical presentation of chronic diarrhea, microcytic anemia, positive anti-tissue transglutaminase IgA antibodies, and an intensely pruritic vesicular rash on extensor surfaces is highly characteristic of celiac disease with associated dermatitis herpetiformis. To establish the diagnosis definitively, biopsies are obtained. A duodenal biopsy in active celiac disease classically demonstrates crypt hyperplasia, partial or complete villous blunting (atrophy), and a prominent increase in intraepithelial lymphocytes. Concurrently, a perilesional skin biopsy in dermatitis herpetiformis will reveal the pathognomonic finding of granular IgA deposits localized to the tips of the dermal papillae on direct immunofluorescence.
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Celiac disease and Dermatitis Herpetiformis pathology
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