Celiac disease with diffuse cutaneous vitamin K-deficiency bleeding.
This article describes a 4-y-old girl with spontaneous, generalized bruising, abdominal distention, and signs of malnutrition. She had been treated previously with an antibiotic for diarrhea. Laboratory analyses showed the presence of iron-deficiency anemia, mild hypoalbuminemia, and considerably prolonged prothrombin time and activated thromboplastin time. Tests revealed that hemostasis improved after the patient received fresh frozen plasma. A coagulation profile showed a decrease in clotting factors II, VII, IX, and X. The patient was given intravenous vitamin K therapy (5 mg/d) for 3 d. All coagulation tests were normalized, and bruising started to disappear. Positive serology (immunoglobulin A antitissue transglutaminase and immunoglobulin A antiendomysial antibodies) and smallbowel mucosal histopathology confirmed the presence of celiac disease (CD). The girl recovered completely after she was put on a gluten-free diet. Vitamin K-deficiency bleeding is a rare complication that occurs almost exclusively in patients with typical CD manifestations. In addition to antibiotic therapy, treatment with other drugs that influence vitamin K resorption and metabolism may increase the risk of bleeding in patients with CD with hypoprothrombinemia.
Djuric
Zlatko
Z
Department of Gastroenterology, Children's Hospital, and Institute of Pathology, University of Nis School of Medicine, Serbia. zldjuric@yahoo.com
Zivic
Sasa
S
Katic
Vuka
V
D002446:Celiac Disease / Q000150:complications* / Q000178:diet therapy; D002675:Child, Preschool; D018753:Diet, Protein-Restricted; D005260:Female; D005983:Glutens / Q000008:administration & dosage; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D010949:Plasma; D014812:Vitamin K / Q000627:therapeutic use; D014813:Vitamin K Deficiency / Q000150:complications* / Q000188:drug therapy; D014815:Vitamins / Q000627:therapeutic use
D014815:Vitamins; D014812:Vitamin K; D005983:Glutens