Celiac crisis, atypical form of celiac disease onset in teenager – a case report

Abstract

Celiac disease (CD) is an immune mediated disorder triggered by gluten diet genetically susceptible individuals. Celiac crisis is a rare but potentially lethal condition that can occur in a previously known celiac disease or as its first manifestation. Case presentation. 15-year-old teenager, with a personal history of anemia for which he did not receive proper treatment, was admitted for semi-loose and steatorrheic stools, weight decrease, loss of appetite, fatigability, drowsiness, from approximately 10 days. The laboratory tests performed at the time of admission showed the following: thrombocytosis, iron deficiency anemia, slight increase of transaminases, mixed hyperbilirubinemia with the predominance of indirect bilirubin, and hyponatremia. We ruled out a potential infectious etiology, and the serology markers for celiac disease were positive. Thus, the diagnosis of celiac crisis has been established as the onset form of celiac disease based on the symptoms, increased anti-transglutaminase (> 10x normal value) and anti-endomysium antibodies. During admission, we administered symptomatic treatment, fluids by vein, and we initiated the gluten-free diet. Three months after the initiation of the gluten-free diet, the patient’s clinical course was favorable and the laboratory tests improved considerably: with negative anti-endomysium antibodies and marked decrease in anti-transglutaminase antibodies value. Conclusions. The celiac crisis should be taken into account in the differential diagnosis of all patients with sudden onset diarrhea, metabolic disorders and weight loss after an infectious etiology has been ruled out, and its recognition is important and facilitates prompt treatment.

Keywords

• celiac disease
• celiac crisis
• anti-transglutaminase antibodies
• anti-endomysium antibodies
• teenager