Celiac Crisis in an Adult on Immunosuppressive Therapy

Abstract

'Celiac crisis' is a rare presentation of celiac disease with manifestations that include severe diarrhea, and severe metabolic and electrolyte abnormalities. It is most frequently seen in children younger than two years of age and has been rarely described in adults. A case of a 50-year-old woman who presented with diarrhea, severe dehydration, hypokalemia and metabolic acidosis is described. Based on positive serology and small bowel biopsy, she was diagnosed with celiac disease. She also had histological evidence of lymphocytic colitis. Microscopic colitis has not previously been described in association with celiac crisis, but it may have contributed to the presentation of celiac crisis in the current case. The patient was on corticosteroids and azathioprine for autoimmune hepatitis at the time of her presentation. The current case demonstrates that modest immunosuppression does not prevent a celiac crisis, although previous reports have shown that patients may respond rapidly to high-dose corticosteroids.

Ischemic Colitis: Surging Waves of Update

“…Routine biochemical tests are helpful but nonspecific. It is of note that patients with ischemic colitis almost always are presented with lactic acidosis, especially in severe cases (Al Shammeri and Duerksen 2008). The diagnosis is usually made by history, examination and endoscopy.…”

Atypical Presentation of Celiac Disease in an Elderly Adult: Celiac Crisis

“…Most individuals in celiac crisis response to a gluten‐free diet as well as these two individuals did, but because of its anti‐inflammatory effect on the intestinal epithelial, some authors suggest corticosteroid therapy for individuals who are resistant to a gluten‐free diet . Bone mineral density revealed total t ‐scores of −5.1 and −4.6, respectively, in these individuals.…”

Celiac Crisis in an Older Man

“…1 It is unusual especially in older adults to present with severe diarrhea resulting in renal failure and metabolic acidosis. 2 Other gastrointestinal symptoms may include steatorrhea, weight loss, and flatulence. Intestinal complaints seem to be less common and prominent in older adults with celiac disease.…”

“…This notion is consistent with the recent findings that dehydration alters the osmotic equilibrium across the BBB and increases BBB permeability. 2 Similarly, dehydration induced hypercortisolemia in experimental animals, 3 which can impair active learning, shortterm memory, and verbal memory. 4,5 Dehydration increases plasma arginine vasopressin concentration, which can alter memory function.…”