Coeliac disease causing symptomatic hypocalcaemia, osteomalacia and coagulapathy

Abstract

A 36-year-old gentleman presented with 6 months of poor energy, tingling in fingers and weight loss with a change in bowel habit. He appeared cachectic and had clubbing, demineralisation of teeth, pectus carinatus, kyphosis, spinal tenderness, proximal muscle weakness and generalised muscle atrophy. Chvostek's and Trosseau's signs were positive. His haemoglobin (Hb) was 8.7 g/dl, MCV 64.7 fl with low iron. Calcium corrected was 1.30 nmol/l, parathyroid hormone 440.4 ng/l, vitamin D <12.5 nmol/l; INR was 2.7 with coagulation inhibitor studies negative. Radiographs of spine and pelvis commented on osteopenia with thoracic kyphosis and mild anterior wedging of thoracic vertebrae. Antitissue transglutaminase was 145 U/ml, and antiendomysial antibodies were positive. An oesophagogastroduodenoscopy was consistent with coeliac disease. A diagnosis of osteomalacia and coagulopathy secondary to coeliac disease was made. The hypocalcaemia was treated with calcium gluconate infusions with symptomatic relief. Coagulopathy was treated with vitamin K intravenously with normalisation of INR. Following treatment with coeliac diet, calcium slowly normalised.

Micronutrients Dietary Supplementation Advices for Celiac Patients on Long-Term Gluten-Free Diet with Good Compliance: A Review

“…If GFD is not sufficient to bring the values in the normal range, supplementation of vitamin D and calcium is required [17,61,62,63]. The Endocrine Society guidelines recommend, for the general population, that serum levels of vitamin D are at least equal to 30 ng/mL, and that it is necessary to decide the dosage of supplementation in relation to the initial value of the subject [64].…”

Hemorrhagic Events in Adult Celiac Disease Patients. Case Report and Review of the Literature

“…In the cases reviewed, different clinical situations explained the development of hemorrhagic events, such as coagulopathy due to vitamin K malabsorption [4,15,20,23,32,44,45,47], celiac crisis [8,13], LHS [14,15,17,18,[33][34][35][36][37][38][39][40], portal hypertension [23], or digestive tumors [19,21,25,41].…”

“…In the remainder, data on coagulation tests were not available. For the coagulopathy treatment, vitamin K [4,9,12,28,29,32,[46][47][48][49][50], fresh frozen plasma [9,12] or coagulation factors [46] were administered.…”

Minimally symptomatic hypocalcaemia unmasking celiac disease

“…7 Emphasis must be given on the clinical manifestations of the disease in adults ranging from common gastrointestinal symptoms like diarrhoea, abdominal pain and weight loss to completely atypical presentations including anaemia, hypocalcaemia and osteoporosis. 4,[8][9][10] Hypocalcaemia, which was the most prominent finding in our patient, is attributed to calcium malabsorption. Normally, calcium is actively absorbed in the small intestine, primarily in the duodenum.…”