{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T05:18:06Z","timestamp":1787894286571,"version":"build-2784847793"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:p>\n                    Type II refractory celiac disease (RCD II) is a rare pre-lymphomatous complication of celiac disease associated with severe malabsorption and a high risk of enteropathy-associated T-cell lymphoma. We report a 56-year-old Tunisian woman with adult-onset celiac disease who developed progressive diarrhea and life-threatening malnutrition despite dietitian-verified adherence to a gluten-free diet. At admission, she weighed 34\u202fkg (body mass index, 12.9\u202fkg\/m\n                    <jats:sup>2<\/jats:sup>\n                    ), was hypotensive and wheelchair dependent, and reported up to 20 stools\/day. She had anemia, hypoalbuminemia, and hypophosphatemia. Computed tomography enterography, whole-body 18F-FDG PET\/CT, jejunoscopy, and ileocolonoscopy found no lymphoma. Duodenal biopsies showed total villous atrophy and &amp;gt;50% aberrant CD3+\/CD7+\/CD8\u2212\/CD30\u2212 intraepithelial lymphocytes, supporting RCD II; flow cytometry and T-cell receptor clonality testing were unavailable. Treatment comprised 1 month of exclusive parenteral nutrition with refeeding-syndrome prophylaxis, 1 month of combined enteral and oral feeding, and subsequent oral nutrition. After systemic corticosteroids failed, open-capsule budesonide was initiated at 6\u202fmg\/day and reduced to 3\u202fmg\/day after 2 months. At 4 months, villous atrophy and the aberrant lymphocyte population were unchanged. At 6 months, however, the patient had gained 26\u202fkg, stool frequency had fallen to 2-3\/day, albumin had normalized, and mobility had improved. This case illustrates that nutritional recovery and intestinal disease activity may diverge in RCD II. Clinical and nutritional remission should not replace endoscopic and immunophenotypic surveillance.\n                  <\/jats:p>","DOI":"10.3389\/fnut.2026.1941830","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T04:32:52Z","timestamp":1787891572000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Nutritional remission without mucosal healing in type II refractory celiac disease: a case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Om Kolthoum","family":"Sallem","sequence":"first","affiliation":[{"name":"Department of Clinical Nutrition, Fattouma Bourguiba University Hospital, Faculty of Medicine of Monastir, University of Monastir","place":["Monastir, Tunisia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asma","family":"Sabbek","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Fattouma Bourguiba University Hospital, Faculty of Medicine of Monastir, University of Monastir","place":["Monastir, Tunisia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nabil Ben","family":"Chaab\u00e8ne","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Fattouma Bourguiba University Hospital, Faculty of Medicine of Monastir, University of Monastir","place":["Monastir, Tunisia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leila","family":"Safer","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Fattouma Bourguiba University Hospital, Faculty of Medicine of Monastir, University of Monastir","place":["Monastir, Tunisia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"823","DOI":"10.1016\/j.cgh.2017.06.037","article-title":"Global prevalence of celiac disease: systematic review and meta-analysis","volume":"16","author":"Singh","year":"2018","journal-title":"Clin Gastroenterol Hepatol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"687","DOI":"10.1097\/MEG.0b013e328133f0c1","article-title":"Prevalence of celiac disease in Tunisia: mass-screening study in schoolchildren","volume":"19","author":"Ben Hariz","year":"2007","journal-title":"Eur J Gastroenterol Hepatol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"S7","DOI":"10.1097\/01.mpg.0000450393.23156.59","article-title":"The new epidemiology of celiac disease","volume":"59","author":"Catassi","year":"2014","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"59","DOI":"10.14309\/ajg.0000000000002075","article-title":"American College of Gastroenterology guidelines update: diagnosis and management of celiac disease","volume":"118","author":"Rubio-Tapia","year":"2023","journal-title":"Am J Gastroenterol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1461","DOI":"10.1053\/j.gastro.2022.07.086","article-title":"AGA clinical practice update on management of refractory celiac disease: expert review","volume":"163","author":"Green","year":"2022","journal-title":"Gastroenterology"},{"key":"ref6","first-page":"e70195","article-title":"European Society for the Study of Coeliac Disease (ESsCD) 2025 updated guidelines on the diagnosis and management of coeliac disease in adults. 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