Coeliac disease and granulomatous ileocolitis: an association or chance occurrence?

Enteric granulomatous inflammation can be caused by a number of conditions including Crohn’s disease, sarcoidosis, enteric infections, chronic granulomatous disease and also by drug reactions. Granulomas have also been described in microscopic colitis associated with certain medications and autoimmune diseases. The association of granulomatous ileocolitis with coeliac disease is not common. We present a case of coeliac disease with granulomatous ileocolitis with follow-up and repeat histology on a gluten-free diet. We discuss the pathological mechanisms leading to the association of granulomatous ileocolitis with coeliac disease as well as other conditions.

Keywords Microscopic colitis, coeliac disease, granuloma, Crohn’s disease

Declaration of Interests  This case was presented at the 2008 United European  Gastroenterology Week at the annual meeting of the European Gastroenterology Federation. Dr Dhar has received honoraria from pharmaceutical companies for lectures, advisory work and consultancy.