Nontropical sprue with several major complications

A 43-yr-old woman with celiac disease had an excellent response to a gluten-free diet for 20 yr. Subsequently, she developed the complications of chronic nongranulomatous ulcerative jejunitis and malignant histiocytosis associated with some atypical clinical and pathological features. The early criteria for surgical intervention, to prevent a rapidly fatal malignant histiocytosis, are described.