Alemtuzumab for Refractory Celiac Disease in a Patient at Risk for Enteropathy-Associated T-Cell Lymphoma

To the Editor: A 56-year-old woman had a two-year history of refractory celiac disease for which she had taken prednisone (20 mg per day) for the previous six months, during which time her condition had worsened despite a gluten-free diet. Duodenal biopsy showed severe atrophy with crypt hyperplasia and increased intraepithelial lymphocyte counts. On immunohistochemical analysis, the cytoplasm was positive for CD3 and negative for CD4 and CD8 (Figure 1). Flow-cytometric analysis of intraepithelial lymphocytes showed that more than 50 percent of the cells expressed T-cell receptor γδ (TCRγδ). In addition, we identified a second aberrant population of intraepithelial lymphocytes, . . .