Treatment of giardiasis reverses "active" coeliac disease to "latent" coeliac disease.
In patients with coeliac disease, a regression of intestinal damage without a gluten-free diet is a very rare event. We describe a young child with diarrhoea, intestinal mucosa atrophy and positive serum anti-endomysial and anti-tissue transglutaminase (anti-tTG) antibodies during intestinal giardiasis infection. He showed normal intestinal mucosa architecture and negative anti-endomysial and anti-tTG antibodies after his giardiasis was cured, although he continued to assume a normal diet. Re-evaluations on a 6-monthly basis showed that he was symptom free, and all haemato-chemical parameters were within normal limits. Three years after the initial diagnosis, a third intestinal biopsy showed: normal mucosa architecture; an increase in the intra-epithelial CD3+ and gamma/delta+ lymphocyte counts; and immunoglobulin-A anti-endomysial antibody detection in the supernatant of the intestinal mucosa culture incubated with gliadin. An active coeliac disease status, with intestinal mucosa atrophy, may regress to a latent coeliac disease status with normal intestinal mucosa histology after removal of the environmental factors that have presumably precipitated mucosa damage. Serum anti-endomysial and anti-tTG antibody behaviour is not a permanent, life-long feature and this must recommend the repetition of anti-endomysial or anti-tTG antibody assays in the same patient whenever coeliac disease diagnosis is again suspected, irrespective of previous negativity.
Carroccio
A
A
Department of Internal Medicine, University Hospital of Palermo, via Coffaro 25, 90124 Palermo, Italy. liwcar@tin.it
Cavataio
F
F
Montalto
G
G
Paparo
F
F
Troncone
R
R
Iacono
G
G
D000981:Antiprotozoal Agents / Q000008:administration & dosage*; D001323:Autoantibodies / Q000032:analysis / Q000097:blood*; D001707:Biopsy, Needle; D002446:Celiac Disease / Q000150:complications / Q000276:immunology* / Q000473:pathology; D004797:Enzyme-Linked Immunosorbent Assay; D005500:Follow-Up Studies; D005873:Giardiasis / Q000150:complications / Q000188:drug therapy* / Q000276:immunology*; D006801:Humans; D007070:Immunoglobulin A / Q000032:analysis / Q000097:blood*; D007150:Immunohistochemistry; D007223:Infant; D007413:Intestinal Mucosa / Q000276:immunology / Q000473:pathology; D008297:Male; D012680:Sensitivity and Specificity; D011503:Transglutaminases / Q000032:analysis / Q000276:immunology*
D000981:Antiprotozoal Agents; D001323:Autoantibodies; D007070:Immunoglobulin A; D011503:Transglutaminases