Successful Treatment of Refractory Sprue with Cyclosporine
Authors: George F. Longstreth
Journal: Annals of Internal Medicine (1993)

Brief Reports15 November 1993Successful Treatment of Refractory Sprue with CyclosporineGeorge F. Longstreth, MDGeorge F. Longstreth, MDFrom Southern California Permanente Medical Group, San Diego, California.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-119-10-199311150-00008 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Celiac sprue is a disorder of absorption that is identified by characteristic histologic abnormalities in the small-bowel mucosa [1, 2]. The clinical and histologic features respond to a gluten-free diet. Patients with refractory sprue do not respond to strict gluten avoidance and have a poor prognosis [3]. A patient with severe sprue who was unresponsive to a gluten-free diet and corticosteroid therapy experienced remission after receiving cyclosporine therapy.Case ReportA 45-year-old woman was hospitalized in January 1986 because of diarrhea (5 to 24 stools/d) for 5 months, vomiting for 6 weeks, and a weight loss of 21 kg. She ...References1. Trier JS. Celiac sprue. N Engl J Med. 1991; 325:1709-19. Google Scholar2. Kelly CP, Feighery CF, Gallagher RB, Weir DG. Diagnosis and treatment of gluten-sensitive enteropathy. Adv Intern Med. 1990; 35:341-64. Google Scholar3. Trier JS, Falchuk ZM, Carey MC, Schreiber DS. Celiac sprue and refractory sprue. Gastroenterology. 1978; 75:307-16. Google Scholar4. Baker AL, Rosenberg IH. Refractory sprue: recovery after removal of nongluten dietary proteins. Ann Intern Med. 1978; 89:505-8. Google Scholar5. Weinstein WM, Saunders DR, Tytgat GN, Rubin CE. Collagenous spruean unrecognized type of malabsorption. N Engl J Med. 1970; 283:1297-301. Google Scholar7. Bernstein EF, Whitington PF. Successful treatment of atypical sprue in an infant with cyclosporine. Gastroenterology. 1988; 95:199-204. Google Scholar8. Sandborn WJ, Tremaine WJ. Cyclosporine treatment of inflammatory bowel disease. Mayo Clin Proc. 1992; 67:981-90. Google Scholar9. Thomson AW, Neild GH. Cyclosporin: use outside transplantation (Editorial). BMJ. 1991; 302:4-5. Google Scholar10. Deray G, Benhmida M, Le Hoang P, Maksud P, Aupetit B, Baumelou A, et al. Renal function and blood pressure in patients receiving long-term, low-dose cyclosporine therapy for idiopathic autoimmune uveitis. Ann Intern Med. 1992:117: 578-83. Google Scholar Author, Article, and Disclosure InformationAuthors: George F. Longstreth, MDAffiliations: From Southern California Permanente Medical Group, San Diego, California.Corresponding Author: George F. Longstreth, MD, Kaiser Medical Center, 4647 Zion Avenue, San Diego, California 92120.Acknowledgment: The author thanks Dr. William Cory for substantial contributions to the patient's care, Dr. Naomi Buckwalter for pathology consultation and the photographs, Dr. Martin F. Kaghoff for DNA typing. 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