Intraepithelial lymphocytes, scores, mimickers and challenges in diagnosing gluten-sensitive enteropathy (celiac disease)

Table 3 Most common duodenal infections potentially mimicking gluten-sensitive enteropathy

	Agent	Villi	CH	LPI	IELs	PMNs	Sup.-D.	Target	Site	Stain
Giardiasis	G. lamblia	0-3A	Nil	0/+/++	< 20/↑	Rarely	Nil	None	IL	GS
Cryptosporidia	C. parvum	1-3A	+	+/++	< 20	Focal	Focally	Enterocytes	IE	WS
Microsporidia	E. bieneusi	1-3A	+	+/++	< 20	Nil	Focally	Enterocytes/macrophages	IEv/ IEc	WS
	E. intestinalis
Cyclospora	C. coyetanensis	1-3A	+	+/++	< 20/↑	Nil	Focally	Enterocytes	IEv	NA
Isospora	I. belli	1-3A	+	+/++	< 20	Nil	Focally	Enterocytes	IEv	NA
Whipple D	T. whipplei	1-3A	Nil	++1	↑	Nil	Nil	Macrophages	LP	PAS
										ZN
MAI	M. avium intracellulare	1-3A	Nil	++1	< 20	Nil	Nil	Macrophages	LP	PAS
										ZN
										AR
Leishmaniasis	L. donovani	1-3A	Nil	+/++	< 20	Nil	Nil	Macrophages	LP	NA
Cryptococcosis	C. neoformans	1-3A	Nil	0/+	< 20	Nil	Nil	None	LP	DPAS
										MS
CMV	Cytomegalovirus	Ulcers	2	+/++	< 20/↑	+/-	Focally	Epithelium/endothelium	LP	IHC

¹Pale macrophages;

²Crypt damage; IIIA partial atrophy, IIIB subtotal atrophy, IIIC total atrophy. 0-3A: 0, no inflammation, 1, IELs, 2 mild hyperplasia/mild inflammation. IL: Intraluminal; IE: Intraepithelial (surface and crypt epithelium); IEv: Intraepithelial at the villous tips; IEc: Intraepithelial at the crypts; LP: Lamina propria; CH: Crypt hyperplasia; AR: Auramine-rhodamine stain; DPAS: Diastase-periodic acid Schiff stain; GS: Giemsa stain; IHC: Immunohistochemistry with antibodies against the cytomegalovirus antigens; MS: Methenamine-silver stain; WS: Warthin-Starry stain; ZN: Ziehl-Nielsen stain.