title: Severe liver damage associated with celiac disease: findings in six toddler-aged girls.
abstract: OBJECTIVE
  Light-to-moderate liver damage is often seen in children diagnosed with celiac disease, but severe liver damage is rarely observed.
  
  
  METHODS
  During a 12-year-long period our center took care of six 13-36-month-old girls who developed severe liver damage 1-24 months after the diagnosis of celiac disease.
  
  
  RESULTS
  Four girls had acute liver failure; two of them had to be liver transplanted. The other four girls recovered without transplantation and none of the six patients developed autoimmune disease during the 2-14-year-long follow-up period. Although adenovirus type 2 was found in the urine and stools of one girl, her liver histopathology did not resemble viral hepatitis. Certain autoimmune features could be observed initially in some of the children but finally none of them fulfilled the criteria for autoimmune liver disease and this pattern did not change during the several years of follow-up. Thorough investigation could not find any alternative pathogenetic cause and thus, the association with celiac disease is obvious. Histopathology showed various degrees of intralobular inflammation, necrosis, involvement of the small bile ducts, and in one case interface hepatitis; but in general, histopathology did not reveal a common pathogenetic mechanism.
  
  
  CONCLUSIONS
  Although rare, severe hepatic damage or failure can develop in association with celiac disease. The etiology is varying and multifactorial. Consequently, children with newly onset celiac disease should be routinely checked for liver function and vice versa, children with severe liver damage should be investigated for untreated celiac disease.
authors.affiliation: Departments of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital, Karolinska University Hospital, Stockholm, Sweden. thomas.casswall@ki.se
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Casswall
authors.forename: Nikos
authors.initials: N
authors.lastname: Papadogiannakis
authors.forename: Sam
authors.initials: S
authors.lastname: Ghazi
authors.forename: Antal
authors.initials: A
authors.lastname: Németh
mesh_terms: D015551:Autoimmunity; D002446:Celiac Disease / Q000150:complications* / Q000175:diagnosis / Q000276:immunology; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008107:Liver Diseases / Q000209:etiology* / Q000276:immunology; D017114:Liver Failure, Acute / Q000209:etiology / Q000276:immunology / Q000601:surgery; D016031:Liver Transplantation