Co-existence of Systemic Lupus Erythematosus and Celiac Disease: A Case Report

Abstract

Systemic Lupus Erythematosus (SLE) is an autoimmune multisystem disease usually affecting mucocutaneous, hematologic, and renal organs. Whereas, Celiac Disease is a chronic digestive and immune disorder of the small intestine leading to diarrhea and malnutrition. We report the case of an 18-year-old girl with chronic diarrhea for 1 year with bilateral feet swelling, photosensitive skin rash over sun-exposed areas, recurrent oral ulcers, marked hair fall, generalized lethargy, and fatigue. On examination, she was underweight having malar butterfly rash, oral ulcers, alopecia, conjunctival pallor, and bilateral pitting pedal edema. Investigations revealed raised ESR, microcytic anemia due to iron deficiency, and low serum albumin. Duodenal biopsy showed villous atrophy, lamina propria inflammation, and intraepithelial lymphocytosis. The autoimmune profile revealed positive anti-tissue transglutaminase (tTG-IgA and tTG-IgG), ANA, anti-DsDNA, and Anti-Sm antibodies with low serum C3 and serum C4 levels. A diagnosis of co-existing Celiac Disease and SLE was made and was managed with a gluten-free diet, steroids, and hydroxychloroquine.

Keywords

• celiac disease
• endoscopy
• prednisolone
• systemic lupus erythematosus