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Inflammatory Bowel Disease II: Crohn's Disease01:30

Inflammatory Bowel Disease II: Crohn's Disease

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Introduction
Inflammatory bowel disease, commonly known as IBD, refers to a collection of disorders that lead to persistent inflammation of the gastrointestinal tract. The two types of IBD are ulcerative colitis, which impacts the colon, and Crohn's disease, which can involve any part of the gastrointestinal segment.
Crohn's disease
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Chronic Bowel Disorders: Introduction01:17

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Chronic bowel diseases are a group of long-term conditions affecting the digestive tract, characterized by inflammation and damage to the gut lining. These conditions primarily include irritable bowel syndrome and inflammatory bowel disease.
Irritable Bowel Syndrome (IBS) is a common disorder affecting the gastrointestinal tract. The distinctive feature is recurrent abdominal pain associated with altered bowel movements, manifesting as constipation, diarrhea, or fluctuating between both. The...
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Immunodeficiency Diseases01:25

Immunodeficiency Diseases

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Immunodeficiency disorders are conditions in which the immune system's ability to fight infectious disease and cancer is compromised or entirely absent. The immune system comprises a complex network of cells, tissues, and organs that work together to protect the body from potentially harmful invaders. When this system is deficient or not functioning properly, it leaves the body susceptible to infections, diseases, or other complications.
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Histology of the Small Intestine01:27

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The small intestine exhibits a unique histological structure that significantly enhances its function in digestion and nutrient absorption. These structures include circular folds, villi, and various specialized cells that collectively facilitate the digestion of food.
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Inflammatory Bowel Disease I: Ulcerative Colitis01:27

Inflammatory Bowel Disease I: Ulcerative Colitis

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Inflammatory bowel disease, or IBD, encompasses a group of disorders characterized by chronic inflammation or ulceration of the gastrointestinal tract.
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The Histologic Spectrum of Rituximab-Associated Common Variable Immunodeficiency-Like Enteropathy.

Pari Jafari1, David Hakimian2, Maria Westerhoff3

  • 1Department of Pathology, University of Chicago Medicine, Chicago, Illinois.

Modern Pathology : an Official Journal of the United States and Canadian Academy of Pathology, Inc
|April 13, 2025
PubMed
Summary
This summary is machine-generated.

Rituximab (RTX) can cause a CVID-like enteropathy with diarrhea and malabsorption. Histopathology reveals plasma cell depletion, villous atrophy, and increased apoptosis, suggesting B-cell impairment.

Keywords:
common variable immunodeficiency enteropathyhypogammaglobulinemiarituximab-associated enteropathy

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Area of Science:

  • Gastroenterology
  • Immunology
  • Pathology

Background:

  • Rituximab (RTX), an anti-CD20 monoclonal antibody, is used for B-cell neoplasms and autoimmune diseases.
  • RTX is increasingly associated with an enteropathy mimicking common variable immunodeficiency (CVID) enteropathy, presenting with diarrhea, malabsorption, and hypogammaglobulinemia.

Purpose of the Study:

  • To conduct the first dedicated histopathologic assessment of RTX-associated CVID-like enteropathy.
  • To characterize the key histologic features in small bowel and colon specimens from patients with RTX-associated enteropathy.

Main Methods:

  • Systematic evaluation of small bowel and/or colon biopsies/resections from 22 patients with RTX exposure and gastrointestinal symptoms.
  • Inclusion criteria: diarrhea, weight loss, or GI symptoms with current/prior RTX use and hypogammaglobulinemia.
  • Histologic features analyzed included plasma cell density, intraepithelial lymphocytosis, villous architecture, crypt apoptosis, and inflammation.

Main Results:

  • Key small bowel findings: sparse/absent lamina propria plasma cells (50%), intraepithelial lymphocytosis (60%), villous atrophy (55%), increased crypt apoptotic bodies (30%).
  • Key colon findings: sparse/absent plasma cells (41.2%), increased crypt apoptotic bodies (41.2%), active inflammation (29.4%), intraepithelial lymphocytosis (23.5%).
  • Goblet cell loss observed in 2 patients; follow-up biopsies largely recapitulated initial findings, with one case showing improvement.

Conclusions:

  • The histologic spectrum of RTX-associated CVID-like enteropathy includes plasma cell depletion, increased crypt apoptosis, villous atrophy, and goblet cell loss.
  • The clinicopathologic findings suggest a potential link to post-RTX B-cell/plasma cell impairment.
  • Pathologists should consider RTX exposure in patients with CVID enteropathy-like histologic features, even if subtle.