Celiac Crisis

an unusual presentation of gluten-sensitive enteropathy

Authors

  • Rômulo Ribeiro do Vale Universidade de São Paulo, Hospital das Clínicas, Department of Internal Medicine.
  • Nathalia da Silva Conci Universidade de São Paulo, Hospital das Clínicas, Department of Internal Medicine.
  • Alexandre Pinheiro Santana Instituto de Infectologia Emilio Ribas.
  • Mauricio Baptista Pereira Universidade de São Paulo, Hospital das Clínicas, Department of Internal Medicine.
  • Natália Yume Hissayasu Menezes Universidade de São Paulo, Hospital das Clínicas, Department of Internal Medicine.
  • Vilma Takayasu Universidade de São Paulo, Hospital Universitário, Internal Medicine Division.
  • Lorena Silva Laborda Universidade de São Paulo, Hospital Universitário, Internal Medicine Division.
  • Aloísio Souza Felipe da Silva Universidade de São Paulo, Hospital Universitário, Anatomic Pathology Service.

DOI:

https://doi.org/10.4322/acr.2018.027

Keywords:

Celiac Disease; Malabsorption Syndrome; Diarrhea, Transglutaminases; Gliadin

Abstract

Celiac disease (CD)—also known as gluten-sensitive enteropathy—is a chronic, genetically predisposing and autoimmune entity with a wide range of clinical manifestations triggered by gluten ingestion, which affects 1% of the general population. Currently, up to 60% of the diagnosis of CD is in adults due to the atypical course of the disease. The severe acute onset of CD—also called celiac crisis—is very uncommon and is still not well documented in adults. We report the case of a 58-year-old man who presented a 45-day history of subtle-onset diarrhea followed by malabsorption syndrome with progressive weight loss, anasarca, and electrolyte disturbances. The diagnostic work-up included an upper digestive endoscopy, which showed scalloping of the duodenal mucosa with pathological features confirmed on biopsies. Specific antibodies were positive, and a satisfactory clinical response was obtained once a gluten-free diet was started. Celiac crisis is a rare initial presentation of CD characterized by severe diarrhea, dehydration, weight loss, hypoproteinemia, and metabolic and electrolyte disturbances. Although rare, it should be considered in patients with apparently unexplained chronic diarrhea.

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Author Biography

Aloísio Souza Felipe da Silva, Universidade de São Paulo, Hospital Universitário, Anatomic Pathology Service.

Universidade de São Paulo, Faculty of Medicine, Department of Pathology.

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Published

2018-08-31

How to Cite

Vale, R. R. do, Conci, N. da S., Santana, A. P., Pereira, M. B., Menezes, N. Y. H., Takayasu, V., Laborda, L. S., & Silva, A. S. F. da. (2018). Celiac Crisis: an unusual presentation of gluten-sensitive enteropathy. Autopsy and Case Reports, 8(3), e2018027. https://doi.org/10.4322/acr.2018.027

Issue

Section

Article / Clinical Case Report