A 60-year-old woman presents with chronic watery diarrhea, weight loss, and arthralgias. Duodenal biopsy shows villous atrophy with a thickened subepithelial collagen band (>10 microns) on trichrome stain. PAS stain is negative. What is the diagnosis?

• A Amyloidosis
• B Whipple disease
• C Collagenous colitis
• D Collagenous sprue ✓

Explanation

Collagenous sprue is characterized by subepithelial collagen deposition greater than 10 microns in the small intestine, causing villous atrophy and malabsorption. It is distinct from collagenous colitis which affects the colon. Whipple disease shows PAS-positive macrophages. Amyloidosis shows Congo red-positive deposits. The thickened collagen band on trichrome stain with negative PAS is diagnostic of collagenous sprue.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

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