An unusual method of diagnosing a common disease

A 34-year-old woman presented with non-bloody diarrhoea of 14 days duration and vomiting. Physical examination was unremarkable. She had hypokalaemia and metabolic acidosis. Stool studies were negative for Clostridium difficile toxin, faecal leucocytes and parasites. Colon appeared normal on colonos...

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Bibliographic Details
Published in:BMJ case reports 2012-11, Vol.2012, p.bcr2012006691
Main Authors: Khangura, Sajneet K, von Rosenvinge, Erik C
Format: Article
Language:English
Subjects:
Adult
Autoantibodies - blood
Biopsy
Bowel disease
Celiac disease
Celiac Disease - diagnosis
Celiac Disease - diet therapy
Celiac Disease - pathology
Colon
Diagnosis, Differential
Diarrhea
Diarrhea - etiology
Diet, Gluten-Free
Electrolytes
Endoscopy, Gastrointestinal
Female
Humans
Ileitis - diagnosis
Ileitis - diet therapy
Ileitis - pathology
Ileum - pathology
Immunoglobulin A - blood
Intestinal Mucosa - pathology
Intubation
Lymphocytosis - diagnosis
Lymphocytosis - pathology
Unusual Presentation of More Common Disease/Injury
USA/Canada
Vomiting - etiology
White
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Summary:A 34-year-old woman presented with non-bloody diarrhoea of 14 days duration and vomiting. Physical examination was unremarkable. She had hypokalaemia and metabolic acidosis. Stool studies were negative for Clostridium difficile toxin, faecal leucocytes and parasites. Colon appeared normal on colonoscopy. Pronounced scalloping of ileal folds was noted on ileoscopy. Ileal biopsies revealed villous blunting, crypt hyperplasia, marked intraepithelial lymphocytosis and lymphocytic infiltration of the lamina propria, consistent with lymphocytic ileitis in coeliac disease. Serology revealed elevated antitissue transglutaminase IgA antibodies (>100 U/ml). Institution of a strict gluten free diet resulted in complete resolution of symptoms. Although rare, coeliac disease can present as an acute diarrhoeal illness and should be considered after infectious aetiologies are excluded.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2012-006691