S3588 Chronic Lymphocytic Gastritis

Abstract

INTRODUCTION: Lymphocytic gastritis (LG) is an uncommon cause of chronic gastritis, accounting for only 5% of cases. The pathology has no clear etiology, however, it is frequently associated with Celiac disease, found in approximately 40% of the patients. H. pylori infection, Crohn’s disease, HIV infection and lymphoma have also been associated in patients with LG. CASE DESCRIPTION/METHODS: A 37-year-old woman with no relevant past medical history who presented to the GI clinic for evaluation of iron deficiency anemia, change in bowel habits, chronic tenesmus and dyspepsia. Menstrual history was unremarkable and anemia did not improved with oral iron supplementation. Laboratory studies showed microcytic normochromic anemia, with an RDW of 15%. Iron profile was consistent with iron deficiency (serum iron of 25 µg/dL and ferritin of 14 ng/mL). Further work up included thyroid studies, vitamin B12 level and testing for celiac disease, which all resulted negative. Subsequent endoscopy and colonoscopy evaluation were unremarkable for macroscopic abnormalities, however, gastric biopsies revealed increased intraepithelial lymphocytosis suggesting a diagnosis of lymphocytic gastritis confirmed via CD3 stain. Colonic biopsies revealed chronic inflammation of lamina propia with intraepithelial lymphocytosis and positive CD3 stain. The patient was started on esomeprazole for lymphocytic gastritis and budesonide for lymphocytic colitis with improvement of symptoms. DISCUSSION: LG is commonly present in middle aged adults, affecting both male and females equally. Initial symptoms are usually non-specific and vary from dyspepsia, nausea, vomiting, diarrhea, anorexia and weight loss. Up to 20% of the cases are labeled as idiopathic, but commonly associated conditions thought to contribute to LG development include autoimmune diseases, infection or environmental influences. Upper endoscopy findings can show nodules, erosions, large gastric folds, or no abnormalities. Diagnosis is achieved by means of histopathological findings, with >25 lymphocytes per 100 epithelial cells. The treatment consists of symptomatic relief, with PPIs or with H. pylori eradication; however, some patients exhibit spontaneous remission. We present this case of refractory iron deficit anemia due LG in a rare location outside the colon resulting in malabsorption.Figure A.: H&E stain of biopsy from nodular gastric mucosa demonstrating increased intraepithelial lymphocytes and expanded lamina propria. Figure B: CD3 stain demonstrated predominant CD3 positive T cells with CD8 co-expression.