Type II refractory celiac disease (RCD II) is a rare pre-lymphomatous complication of celiac disease associated with severe malabsorption and a high risk of enteropathy-associated T-cell lymphoma. We report a 56-year-old Tunisian woman with adult-onset celiac disease who developed progressive diarrhea and life-threatening malnutrition despite dietitian-verified adherence to a gluten-free diet. ...