Celiac crisis, a rare and profound presentation of celiac disease: a case report
Abstract Background Celiac crisis is a life-threatening manifestation of celiac disease and is rare in adults, with only a handful of cases documented worldwide and mostly in children. Case presentation A profoundly emaciated 43-year-old female presented with profuse diarrhoea, shortness of breath,...
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| Format: | Article |
| Language: | English |
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BMC
2018-05-01
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| Series: | BMC Gastroenterology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12876-018-0784-0 |
| _version_ | 1818873559861166080 |
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| author | Elizabeth Ann Forrest Mark Wong Srinivasa Nama Siddharth Sharma |
| author_facet | Elizabeth Ann Forrest Mark Wong Srinivasa Nama Siddharth Sharma |
| author_sort | Elizabeth Ann Forrest |
| collection | DOAJ |
| description | Abstract Background Celiac crisis is a life-threatening manifestation of celiac disease and is rare in adults, with only a handful of cases documented worldwide and mostly in children. Case presentation A profoundly emaciated 43-year-old female presented with profuse diarrhoea, shortness of breath, left leg swelling with ulceration and immobility (Body Mass Index (BMI) = 14.7 kg/m2). The patient had normal anion-gap metabolic acidosis (pH = 7.16) with persisting hypokalemia, hyponatremia, hypomagnesemia and hypophosphatemia. In addition, severe vitamin deficiencies and coagulopathy were present. A computed tomography pulmonary angiogram (CT-PA) revealed bilateral massive pulmonary embolism causing infarction, arising from a left lower limb extensive deep vein thrombosis (DVT). Bone marrow suppression was seen on aspirate. The patient developed severe urosepsis in her immunocompromised state. Prolonged lower limb weakness despite supportive therapy, rehabilitation and strict adherence to a gluten-free diet prompted the magnetic resonance imaging (MRI) confirmed diagnosis of subacute combined degeneration of the spinal cord due to Vitamin-B12 deficiency. Conclusions Celiac crisis is a rare and potentially life-threatening presentation of celiac disease, often a diagnosis of exclusion. Subacute combined degeneration of the spinal cord should be considered in patients with chronic Vitamin B12 deficiency presenting with neurological symptoms. |
| first_indexed | 2024-12-19T12:56:38Z |
| format | Article |
| id | doaj.art-371dcfe8405b4837a7f7798d562cdf57 |
| institution | Directory Open Access Journal |
| issn | 1471-230X |
| language | English |
| last_indexed | 2024-12-19T12:56:38Z |
| publishDate | 2018-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Gastroenterology |
| spelling | doaj.art-371dcfe8405b4837a7f7798d562cdf572022-12-21T20:20:22ZengBMCBMC Gastroenterology1471-230X2018-05-011811410.1186/s12876-018-0784-0Celiac crisis, a rare and profound presentation of celiac disease: a case reportElizabeth Ann Forrest0Mark Wong1Srinivasa Nama2Siddharth Sharma3Diagnostic, Emergency and Medical Services, Gold Coast Hospital and Health ServiceDiagnostic, Emergency and Medical Services, Gold Coast Hospital and Health ServiceDiagnostic, Emergency and Medical Services, Gold Coast Hospital and Health ServiceDiagnostic, Emergency and Medical Services, Gold Coast Hospital and Health ServiceAbstract Background Celiac crisis is a life-threatening manifestation of celiac disease and is rare in adults, with only a handful of cases documented worldwide and mostly in children. Case presentation A profoundly emaciated 43-year-old female presented with profuse diarrhoea, shortness of breath, left leg swelling with ulceration and immobility (Body Mass Index (BMI) = 14.7 kg/m2). The patient had normal anion-gap metabolic acidosis (pH = 7.16) with persisting hypokalemia, hyponatremia, hypomagnesemia and hypophosphatemia. In addition, severe vitamin deficiencies and coagulopathy were present. A computed tomography pulmonary angiogram (CT-PA) revealed bilateral massive pulmonary embolism causing infarction, arising from a left lower limb extensive deep vein thrombosis (DVT). Bone marrow suppression was seen on aspirate. The patient developed severe urosepsis in her immunocompromised state. Prolonged lower limb weakness despite supportive therapy, rehabilitation and strict adherence to a gluten-free diet prompted the magnetic resonance imaging (MRI) confirmed diagnosis of subacute combined degeneration of the spinal cord due to Vitamin-B12 deficiency. Conclusions Celiac crisis is a rare and potentially life-threatening presentation of celiac disease, often a diagnosis of exclusion. Subacute combined degeneration of the spinal cord should be considered in patients with chronic Vitamin B12 deficiency presenting with neurological symptoms.http://link.springer.com/article/10.1186/s12876-018-0784-0Celiac diseaseGlutenCeliac crisisSubacute degeneration of the spinal cordVitamin B12 deficiencyPulmonary embolism |
| spellingShingle | Elizabeth Ann Forrest Mark Wong Srinivasa Nama Siddharth Sharma Celiac crisis, a rare and profound presentation of celiac disease: a case report BMC Gastroenterology Celiac disease Gluten Celiac crisis Subacute degeneration of the spinal cord Vitamin B12 deficiency Pulmonary embolism |
| title | Celiac crisis, a rare and profound presentation of celiac disease: a case report |
| title_full | Celiac crisis, a rare and profound presentation of celiac disease: a case report |
| title_fullStr | Celiac crisis, a rare and profound presentation of celiac disease: a case report |
| title_full_unstemmed | Celiac crisis, a rare and profound presentation of celiac disease: a case report |
| title_short | Celiac crisis, a rare and profound presentation of celiac disease: a case report |
| title_sort | celiac crisis a rare and profound presentation of celiac disease a case report |
| topic | Celiac disease Gluten Celiac crisis Subacute degeneration of the spinal cord Vitamin B12 deficiency Pulmonary embolism |
| url | http://link.springer.com/article/10.1186/s12876-018-0784-0 |
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