Celiac Crisis

• Main Authors: Rômulo Ribeiro do Vale, Nathalia da Silva Conci, Alexandre Pinheiro Santana, Mauricio Baptista Pereira, Natália Yume Hissayasu Menezes, Vilma Takayasu, Lorena Silva Laborda, Aloísio Souza Felipe da Silva
• Format: Article
• Language: English
• Published: University of São Paulo 2018-08-01
• Series: Autopsy and Case Reports
• Subjects: Celiac Disease; Malabsorption Syndrome; Diarrhea, Transglutaminases; Gliadin
• Online Access: http://www.revistas.usp.br/autopsy/article/view/149953

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.