title: Autoimmune hepatitis, cryoglobulinaemia and untreated coeliac disease: a case report.
abstract: The clinical presentation of adult coeliac disease is often uncharacteristic, with extraintestinal symptoms being the main findings. We report a 48-year-old woman who presented with type II, hepatitis-C-negative cryoglobulinaemia, elevated liver enzymes, and iron deficiency. Antinuclear antibodies were positive, and immunoglobulin G (IgG) levels were elevated. On liver biopsy, a diagnosis of type I autoimmune hepatitis with a possible autoimmune cholangitis overlap syndrome was made. Immunosuppressive treatment led to a normalization of transaminase levels and resolved the cryoglobulinaemic vasculitis. In addition, the patient exhibited low ferritin and iron levels, which led to the diagnosis of coeliac disease. Long-standing, untreated coeliac disease is recognized to be a trigger for autoimmune disorders and is known to be associated with other autoimmune diseases, but the association with autoimmune hepatitis or autoimmune cholangitis is reported rarely. We conclude that in patients with autoimmune liver disease and unspecific clinical signs, such as iron deficiency, coeliac disease must be ruled out.
authors.affiliation: Department of Clinical Pharmacology, University of Berne, Berne, Switzerland.
authors.forename: Erwin
authors.initials: E
authors.lastname: Biecker
authors.forename: Muriel
authors.initials: M
authors.lastname: Stieger
authors.forename: Arthur
authors.initials: A
authors.lastname: Zimmermann
authors.forename: Jürg
authors.initials: J
authors.lastname: Reichen
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001379:Azathioprine / Q000627:therapeutic use; D002446:Celiac Disease / Q000150:complications* / Q000188:drug therapy; D003449:Cryoglobulinemia / Q000150:complications* / Q000188:drug therapy; D005260:Female; D019693:Hepatitis, Autoimmune / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use
chemical_list: D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D001379:Azathioprine; D011241:Prednisone