Polyostotic osteonecrosis in a patient with celiac disease.
OBJECTIVE
To emphasize the role of history and physical examination in the clinical evaluation of hypocalcemia and to describe a patient with celiac sprue and multiple osteonecrosis, a previously unrecognized association.


METHODS
A case report is presented of a 39-year-old man with mild hypocalcemia, diarrhea, and arthralgias, and the appropriate clinical and laboratory assessment for these complaints is outlined.


RESULTS
Secondary hyperparathyroidism, celiac sprue, and extensive osteonecrosis were detected by hematologic and radiologic studies. The hematologic variables normalized after institution of a gluten-free diet and calcium supplementation.


CONCLUSIONS
This is the first report of celiac sprue and osteonecrosis in one patient. A possible causal relationship due to secondary hyperparathyroidism is suggested, and alternative explanations are discussed.
Agrawal
L
L
Division of Endocrinology & Metabolism, Loyola University Medical Center, Maywood, Illinois 60153, USA.