Small bowel biopsy showed mild blunting of the villi, with epithelial and subepithelial lymphocytic infiltration [Figure 1]. Biopsies from various parts of the colon and from the terminal ileum showed intraepithelial and subepithelial lymphocytic infiltration suggestive of lymphocytic colitis [Figure 1]. With the presence of only mild villous blunting in the duodenal biopsy (and not total villous atrophy), negative celiac disease serology (which is positive in more than 95% of cases of celiac disease), normal values of serum iron and folate,, and the typical endoscopic and histopathologic criteria of MC, we arrived at the diagnosis of lymphocytic enterocolitis. A collective diagnosis of SLE, antiphospholipid syndrome, and microscopic ‘lymphocytic’ enterocolitis was made. Considering the coexistence of MC with other manifestations of SLE, oral prednisolone 1 mg/kg/day was started; loperamide was prescribed for symptomatic relief.
I'm totally bewildered by the fact that they treated her with 15 mgs of prednisone daily, forever, without examining the possibility that diet may play a role, especially when she had pathologic evidence of celiac disease!! Isn't villus blunting, however mild, still the gold standard?? Why the heck were they looking for anemia and positive blood antibodies, when they had a gold standard result?? This woman's SLE is probably spiralling out of control because she doesn't have instructions to address her diet. Shame on them!!
