Reactive autoimmune-like enteropathy in the setting of a chlamydia infection: A case report

A 16-year-old female presenting with acute left-sided abdominal pain, diarrhea, nausea, and vomiting associated with a 20-lb weight loss. She was found to have positive chlamydia polymerase chain reaction upon admission. She underwent endoscopy and colonoscopy, with pathology revealing marked inflammation, complete villous blunting with absence of goblet and Paneth cells, with increased crypt apoptosis of the proximal duodenum through terminal ileum, concerning for autoimmune enteropathy. Anti-enterocyte autoantibodies were positive. She was treated with 14 days of doxycycline for her chlamydia infection and had symptomatic improvement without immunomodulatory therapies. Repeat endoscopy 6 months after completion of antimicrobials showed histologic improvement, with the presence of some goblet and Paneth cells, and only mild villous blunting. Together, her histology and clinical response suggest that she exhibited an autoimmune-like enteropathy, though the resolution of her symptoms without steroids suggests this was not a true autoimmune process.