Lymphadenopathy in celiac disease: computed tomographic observations

Lymphadenopathy in patients with celiac disease is generally viewed with alarm due to the association between celiac disease and intestinal lymphoma. Four patients with celiac disease are described in whom significant mesenteric and paraaortic adenopathy was demonstrated by computed tomography (CT). The subsequent clinical course of these patients revealed no evidence of lymphoma. In two patients with longstanding celiac disease and recent relapse, exploratory laparotomy revealed reactive hyperplasia in the enlarged glands; in one patient this was associated with intestinal ulceration, and in the other no underlying pathology was found. Follow-up CT scans in both these patients demonstrated regression of the findings with clinical improvement. In the other two patients, CT was performed as part of the initial evaluation. Follow-up CT in one of these patients revealed almost complete regression of the adenopathy after institution of a gluten-free diet. The other, with a 2 year duration of CT-documented abdominal adenopathy prior to diagnosis, became asymptomatic with weight gain for over 1 year after institution of a gluten-free diet.