Coeliac disease associated with sarcoidosis and antiphospholipid syndrome: A case report
Background: Sarcoidosis is a clinically heterogenous disease of unknown etiology with a hallmark of the development and accumulation of non-caseating granulomas in any organ. The antiphospholipid syndrome (APS) is an autoimmune disorder characterized by an elevated risk for arterial and venous throm...
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doaj-14d350ca24f743ccb2e5dc88ae22a7612020-11-24T23:17:55ZengElsevierEgyptian Rheumatologist1110-11642017-07-0139319119310.1016/j.ejr.2017.02.005Coeliac disease associated with sarcoidosis and antiphospholipid syndrome: A case reportMelek Kechida0Noel Lorenzo Villalba1Internal Medicine and Endocrinology Department, Fattouma Bourguiba Hospital, Monastir, TunisiaHospital Universitario de Gran Canaria, SpainBackground: Sarcoidosis is a clinically heterogenous disease of unknown etiology with a hallmark of the development and accumulation of non-caseating granulomas in any organ. The antiphospholipid syndrome (APS) is an autoimmune disorder characterized by an elevated risk for arterial and venous thrombosis and pregnancy-related morbidity. Celiac disease (CD) is a chronic, immune-mediated form of enteropathy that is now presenting later in life and often with extraintestinal manifestations. Co-existence of sarcoidosis, CD and APS is extremely rare. Case presentation: We describe a 27-year-old Tunisian woman with a history of non-explored superficial vein thrombosis and 4 successive miscarriages, who was explored for abdominal pain, vomiting, hypercalcemia, hepatic cytolyses and cholestasis and was complicated later with pancreatitis and anterior uveitis. Hepatic biopsy revealed noncaseating-granulomas, a high serum angiotensin converting enzyme activity was detected and the diagnosis of sarcoidosis was considered. A high titer of antiphopsholipid antibodies concluded the diagnosis of APS. Duodenal biopsies showed a total villous atrophy indicative of CD, confirmed by positivity of serum anti-endomisium and anti-transglutaminase antibodies. She had normocytic anemia (hemoglobin 9 g/dl) and elevated transaminases. Thorough investigation established the diagnosis of extra pulmonary sarcoidosis associated with CD and APS. Conclusion: Co-existence of sarcoidosis, CD and APS is extremely rare. APS should be recognized as an accompanying disorder of sarcoidosis and antiphospholipids measured especially when there is a history of thrombosis or miscarriages. CD should not be overlooked in association to sarcoidosis, given the shared immunological and genetic background, even in the absence of a typical presentation of the disease.http://www.sciencedirect.com/science/article/pii/S1110116417300261SarcoidosisAntiphospholipid syndromeCeliac diseaseAuto immunityPancreatitis |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Melek Kechida Noel Lorenzo Villalba |
spellingShingle |
Melek Kechida Noel Lorenzo Villalba Coeliac disease associated with sarcoidosis and antiphospholipid syndrome: A case report Egyptian Rheumatologist Sarcoidosis Antiphospholipid syndrome Celiac disease Auto immunity Pancreatitis |
author_facet |
Melek Kechida Noel Lorenzo Villalba |
author_sort |
Melek Kechida |
title |
Coeliac disease associated with sarcoidosis and antiphospholipid syndrome: A case report |
title_short |
Coeliac disease associated with sarcoidosis and antiphospholipid syndrome: A case report |
title_full |
Coeliac disease associated with sarcoidosis and antiphospholipid syndrome: A case report |
title_fullStr |
Coeliac disease associated with sarcoidosis and antiphospholipid syndrome: A case report |
title_full_unstemmed |
Coeliac disease associated with sarcoidosis and antiphospholipid syndrome: A case report |
title_sort |
coeliac disease associated with sarcoidosis and antiphospholipid syndrome: a case report |
publisher |
Elsevier |
series |
Egyptian Rheumatologist |
issn |
1110-1164 |
publishDate |
2017-07-01 |
description |
Background: Sarcoidosis is a clinically heterogenous disease of unknown etiology with a hallmark of the development and accumulation of non-caseating granulomas in any organ. The antiphospholipid syndrome (APS) is an autoimmune disorder characterized by an elevated risk for arterial and venous thrombosis and pregnancy-related morbidity. Celiac disease (CD) is a chronic, immune-mediated form of enteropathy that is now presenting later in life and often with extraintestinal manifestations. Co-existence of sarcoidosis, CD and APS is extremely rare.
Case presentation: We describe a 27-year-old Tunisian woman with a history of non-explored superficial vein thrombosis and 4 successive miscarriages, who was explored for abdominal pain, vomiting, hypercalcemia, hepatic cytolyses and cholestasis and was complicated later with pancreatitis and anterior uveitis. Hepatic biopsy revealed noncaseating-granulomas, a high serum angiotensin converting enzyme activity was detected and the diagnosis of sarcoidosis was considered. A high titer of antiphopsholipid antibodies concluded the diagnosis of APS. Duodenal biopsies showed a total villous atrophy indicative of CD, confirmed by positivity of serum anti-endomisium and anti-transglutaminase antibodies. She had normocytic anemia (hemoglobin 9 g/dl) and elevated transaminases. Thorough investigation established the diagnosis of extra pulmonary sarcoidosis associated with CD and APS.
Conclusion: Co-existence of sarcoidosis, CD and APS is extremely rare. APS should be recognized as an accompanying disorder of sarcoidosis and antiphospholipids measured especially when there is a history of thrombosis or miscarriages. CD should not be overlooked in association to sarcoidosis, given the shared immunological and genetic background, even in the absence of a typical presentation of the disease. |
topic |
Sarcoidosis Antiphospholipid syndrome Celiac disease Auto immunity Pancreatitis |
url |
http://www.sciencedirect.com/science/article/pii/S1110116417300261 |
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