Late mucosal relapse in a boy with coeliac disease and cow's milk allergy

A case of coeliac disease where exceptionally long gluten challenge was needed to produce mucosal relapse is presented. An initial diagnosis of intestinal cow's milk allergy with total villous atrophy was made at the age of 3.5 months. The lesion healed after the child was put on a diet free of cow's milk and gluten. After 4.3 years on a normal diet his jejunal structure was still normal but at the age of 10.9 years, after 8.7 years of gluten ingestion, total villous atrophy was again observed. On a gluten-free diet the small intestinal structure is completely normal at the age of 17.1 years.