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• W2922131452 abstract "Celiac Disease (CD) is a systemic immune mediated disorder that affects genetically predisposed individuals exposed to gluten. Diagnosis of CD is straight forward; however, in some cases diagnosis of CD is challenging. An 85 year-old European male with a history of hypothyroidism and depression presents with complaints of fatigue, decreased appetite, and a 25 pound weight loss over 3 months. On review of systems the patient endorsed intermittent diarrhea for over 10 years with no triggers. A recent colonoscopy was negative. His primary care physician ordered a CT chest, abdomen, and pelvis to search for malignancy which was negative. On admission, the patient's vital signs were normal. Physical examination was remarkable for a cachectic male with temporal wasting, dry mucous membranes, conjunctival pallor and abdominal distention. Cardiovascular examination revealed an irregularly irregular rhythm. The rest of the exam was normal. Laboratory data was showed vitamin D deficiency and iron deficiency anemia with a hemoglobin of 11.4 g/dl. TSH was within normal limits. During the hospital course the patient was found to have ascites and an MRI of the abdomen showed thickening of the small bowel loops. In the hospital, the patient continued to have diarrhea; an IGA anti TTG antibody was drawn which came back at zero. The patient underwent EGD with biopsy of the duodenum. A paracentesis showed secondary spontaneous bacterial peritonitis with subsequent pneumoperitoneum requiring small bowel resection. Biopsy results from the EGD came back positive for CD; small bowel resected pathology revealed enteropathy associated T cell lymphoma (EATL). The patient remained critically ill and the family decided to send the patient to hospice care where he eventually expired. The clinical manifestations of CD include diarrhea, steatorrhea, weight loss, flatulence, and vitamin deficiency. Other manifestations include neuropsychiatric disease such as depression and kidney disease. Sometimes, patients may exhibit atypical celiac disease with only minor gastrointestinal complaints which may delay diagnosis. It is known that long term untreated CD poses an increased risk of malignancy. The case above highlights the fatal outcome of a patient who had a treatable cause (CD) which went undiagnosed for many years. Diagnostic delay of CD has poor outcomes and so a complete outpatient screening should be performed in patients presenting with non-specific gastrointestinal symptoms." @default.
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• W2922131452 date "2018-10-01" @default.
• W2922131452 modified "2023-09-27" @default.
• W2922131452 title "A Deadly Diagnostic Dilemma of Celiac Disease" @default.
• W2922131452 doi "https://doi.org/10.14309/00000434-201810001-02588" @default.
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