An Unusual Presentation of Celiac Disease in an Adult as Celiac Crisis

Document Type

Conference Proceeding

Publication Date

10-2024

Publication Title

American Journal of Gastroenterology

Abstract

Introduction: Celiac crisis is an uncommon but potentially life-threatening manifestation of celiac disease characterized by sudden onset of profuse diarrhea with severe metabolic abnormalities. In this report, we present an adult patient with celiac crisis. Case Description/Methods: A 56-year-old man with history of diabetes mellitus and hypertension presented with 1 month history of bloody diarrhea with 5-6 bowel movements a day. He has presented to multiple hospitals and received antibiotic treatments, and as his symptoms have been persistent, he presented to our hospital. On presentation, he was afebrile, his blood pressure was 110/70 mmHg, heart rate was 72 bmp, and SpO2 at 97% on room air. Physical examination was remarkable for dry mucous membranes and hyperactive bowel sounds. No tenderness to palpation was present on abdominal exam. Laboratory workup was remarkable for hemoglobin at 9.1 g/dL (14-17.5 g/dL), mean corpuscular volume at 66.8 mm3 (80-96 mm3), white blood cells at 9.22 x103/mL (4.4-11.4 x103/mL, 64% neutrophils, 28% lymphocytes), platelets at 391 x109/L (150-450 x109/L), C-reactive protein at 1.33 mg/L (0-5 mg/L), aspartate aminotransferase: 34.7 U/L (, 35 U/L), alanine transaminase: 53.9 (8-37 U/L), creatinine 0.6 (0.5-1.1 mg/dL), phosphorus at 0.93 mg/dl (2.7-4.5 mg/dl), potassium at 2.33 mmol/L (3.5-5.1 mmol/L). Venous blood gas pH at 7.1 (7.32-7.43). Ferritin was 12.40 ng/mL (30-400 ng/mL), iron: 18.9 mcg/dL (59- 158 mcg/dL). Stool culture, C. difficile and E. histolytica were negative. HIV 1/2 tests were negative. Anti-endomysium and tissue transglutaminase immunoglobulin A were positive. An esophagogastroduodenoscopy and colonoscopy were performed with findings of normal esophagus, gastric fundus and body, and gastric antrum was hyperemic. Duodenum was notable for scalloped duodenal folds and edematous appearance. Multiple biopsies were obtained from duodenum with findings consistent with gluten enteropathy and complete villous atrophy (Marsh type 3c). H. pylori was negative on gastric biopsies. Intravenous fluids and electrolyte supplementations for potassium, magnesium, and phosphorus were started and the patient’s symptoms have remarkably improved. Intravenous iron was started. Gluten-free diet was initiated and the patient was discharged after clinical and laboratory improvements. Discussion: The clinical manifestations of celiac disease can vary from asymptomatic presentations to life-threatening such as celiac crisis. Severe acute onset of celiac crisis is very rarely seen in adults. In adults with profuse diarrhea and metabolic abnormalities, celiac disease should be considered as a differential diagnosis.

Volume

119

Issue

10S

First Page

S2993

Comments

American College of Gastroenterology Annual Scientific Meeting, October 25-30, 2023, Philadelphia, PA

DOI

10.14309/01.ajg.0001048296.11805.27

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