Collagenous Enteritis - An Alternative Cause of Malabsorptive Enteropathy

Collagenous Enteritis (CE) is a recently described and rare pathological diagnosis characterized by intestinal villus blunting, intraepithelial lymphocytic infiltrate, and expanded subepithelial collagenous bands. Case Presentation: We discuss the case of a 40-year-old woman with prior history of cervical cancer who presented to our center with a two-year history of progressive unintentional weight loss (32 kg), chronic diarrhea, and severe malnutrition. During this time, she was labeled as having celiac disease but despite documented adherence to a prolonged gluten-free diet, she continued to experience diarrhea, fatigue, and weight loss. After extensive workup, pathology from a follow-up push enteroscopy revealed the presence of intestinal intraepithelial lymphocytosis and severe villus blunting in addition to a patchy enlarged subepithelial collagen layer characteristic of CE extending from the duodenum to the terminal ileum. Conclusion: With a better understanding of CE and its response to various treatment modalities, a more favorable outlook has replaced its once grim prognosis. Discontinuation of offending medications and initiation of corticosteroids remain the mainstay of therapy, often with favorable outcomes. In our case, treatment with corticosteroids and maintenance on a strict gluten-free diet resulted in significantly reduced stool output and gradual weight gain.