False-positive gliadin and endomysium antibodies and exocrine pancreatic insufficiency as pitfalls in the differential diagnosis of duodenal Crohn's versus celiac disease.
We report a 13-yr-old boy with Crohn's disease in the upper gastrointestinal tract presenting with abdominal pain, failure to thrive, recurrent fever, iron-deficient anemia, and exocrine pancreatic insufficiency. Initially, latent celiac disease was suggested because of normal endoscopic findings, the finding of non-specific inflammation on histological evaluation of duodenal biopsies, positive IgA and IgG gliadin, as well as endomysium antibodies and exocrine pancreatic insufficiency. There was no response to a gluten-free diet. A reevaluation revealed Crohn's disease.
University Children's Hospital, Münster, Germany.
P
P
Weber
K P
KP
Zimmer
S
S
Husemann
E
E
Harms
D015746:Abdominal Pain / Q000175:diagnosis; D000293:Adolescent; D018798:Anemia, Iron-Deficiency / Q000175:diagnosis; D000906:Antibodies; D002446:Celiac Disease / Q000175:diagnosis* / Q000178:diet therapy; D003424:Crohn Disease / Q000175:diagnosis*; D003937:Diagnosis, Differential; D018753:Diet, Protein-Restricted; D004044:Dietary Proteins / Q000008:administration & dosage; D004378:Duodenal Diseases / Q000175:diagnosis*; D010188:Exocrine Pancreatic Insufficiency / Q000175:diagnosis*; D005183:Failure to Thrive / Q000175:diagnosis; D005189:False Positive Reactions; D005334:Fever / Q000175:diagnosis; D005903:Gliadin / Q000032:analysis*; D005983:Glutens / Q000008:administration & dosage; D006801:Humans; D007070:Immunoglobulin A / Q000032:analysis; D007074:Immunoglobulin G / Q000032:analysis; D008297:Male; D018485:Muscle Fibers, Skeletal / Q000648:ultrastructure*; D012008:Recurrence
D000906:Antibodies; D004044:Dietary Proteins; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D005983:Glutens; D005903:Gliadin