Adult-onset autoimmune-type enteropathy: potential relationship to an adverse drug reaction

To describe an example of adult-onset autoimmune enteropathy (AIE) that coincided with drug-induced reaction.

A 54-year-old patient was presented with Stevens-Johnson syndrome after a course of quinolones. This was followed shortly thereafter by epigastric pain, diarrhoea and weight loss. She also developed an autoimmune neutropenia.

Several biopsies were performed from the upper and lower gastrointestinal tract (GIT). The duodenal biopsies showed intraepithelial lymphocytosis; therefore, coeliac disease was considered. However, confirmatory serology was negative and the patient did not respond to a gluten-free/gliadin-free diet. Both upper and lower GIT biopsies consistently showed an absence of goblet cells resembling the changes of an AIE.

This is an unusual case of autoimmune-pattern enteropathy in an adult that was potentially drug-induced.