Adult-onset autoimmune enterocolopathy initially presenting with lower gastrointestinal histologic findings: A case report and review of literature

Autoimmune enterocolopathy (AIE) is an immune-mediated disease effecting the gastrointestinal tract that has been increasingly recognized in adults. Prior reports of adult-onset AIE, as well as published diagnostic criteria, emphasize the histopathologic findings in the small bowel to support the diagnosis. However, AIE is known to be a pan-enteric disease, and the initial histologic findings could be first encountered at non-small bowel sites. Here, we report a case of adult-onset AIE, where the initial histologic findings of AIE manifested in the colon as marked loss of goblet cells and prominent basal apoptoses. We review the differential diagnostic considerations, and discuss the subsequent clinical workup needed to evaluate for AIE if it is suspected on a colon biopsy. Additionally, a literature review was performed to determine the histopathologic characteristics of adult-onset AIE in the colon. Overall, the present case report, as well as findings from the literature review, suggest that AIE should enter the differential diagnosis in an adult patient with diarrhea when loss of goblet cells and prominent basal apoptoses are observed in a patient’s colon biopsy, especially when alternative etiologies are not supported by appropriate clinical context.