{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:04:15Z","timestamp":1756339455507,"version":"3.44.0"},"reference-count":6,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2018,4,7]]},"abstract":"<jats:p>A 21-year-old woman presented with a 2-week history of vomiting, diarrhoea and epigastric pain, with 9\u2009kg weight loss over the last two\u2009months. Laboratory tests were normal with negative coeliac serology. Duodenal biopsies revealed total villous atrophy, crypt hypertrophy and intraepithelial lymphocytosis. A diagnosis of seronegative coeliac disease was made, and she started a gluten-free diet. However, she did not respond and her weight fell to 30.6\u2009kg (body mass index 11), becoming dependent on parenteral nutrition. Her diagnosis was reconsidered and the histology reviewed. The histopathological features were of severe active chronic duodenitis. By diagnosis of exclusion, with the absence of other clear pathology, she was treated as Crohn\u2019s disease. She responded to third-line therapy with biologics. In this case, the patient had refractory villous atrophy and the mucosal features, in addition to response with anti-tumour necrosis factor therapy, suggest inflammatory bowel disease, although not with complete diagnostic certainty.<\/jats:p>","DOI":"10.1136\/bcr-2018-224397","type":"journal-article","created":{"date-parts":[[2018,5,26]],"date-time":"2018-05-26T08:29:36Z","timestamp":1527323376000},"page":"bcr-2018-224397","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Seronegative enteropathy and malnutrition: a diagnostic challenge"],"prefix":"10.1136","volume":"2018","author":[{"given":"James","family":"McCulloch","sequence":"first","affiliation":[{"name":"Emergency Department, The Tweed Hospital, Tweed Heads, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miriam","family":"Barclay","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Colchester Hospital University NHS Foundation Trust, Colchester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam","family":"Levene","sequence":"additional","affiliation":[{"name":"Department of Histopathology, Luton and Dunstable University Hospital, Luton, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Fearn","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Homerton University Hospital NHS Foundation Trust, London, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,5,26]]},"reference":[{"key":"2025082707190990000_2018.may25_1.bcr-2018-224397.1","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.jaut.2016.03.016","article-title":"HLA-DQ2.5 genes associated with celiac disease risk are preferentially expressed with respect to non-predisposing HLA genes: implication for anti-gluten T cell response","volume":"70","author":"Pisapia","year":"2016","journal-title":"J Autoimmun"},{"key":"2025082707190990000_2018.may25_1.bcr-2018-224397.2","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2016-312271"},{"key":"2025082707190990000_2018.may25_1.bcr-2018-224397.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2012.06.003"},{"key":"2025082707190990000_2018.may25_1.bcr-2018-224397.4","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2015-309690"},{"key":"2025082707190990000_2018.may25_1.bcr-2018-224397.5","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2013.45"},{"key":"2025082707190990000_2018.may25_1.bcr-2018-224397.6","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2011.04938.x"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2018-224397","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T14:19:18Z","timestamp":1756304358000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2018-224397"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,5,26]]},"references-count":6,"alternative-id":["10.1136\/bcr-2018-224397"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2018-224397","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2018,5,26]]}}}