title: Sero-negative celiac disease with dermatitis herpetiformes: a case report.
abstract: BACKGROUND
  We report a case of sero-negative celiac disease in Pakistan.
  
  
  METHODS
  A 20-year-old female presented with papulovesicular rash for 15 years, diarrhea for 8 years, spasms of hands and twitching of face for 4-5 months. She had mild anemia, low vitamin-D3 and serum calcium. On exclusion of other causes of malabsorption, anti-tissue transglutaminase antibodies (immunoglobulin-A & immunoglobulin-G), anti-endomysial antibodies, total immunoglobulin-A levels and skin biopsy were performed, which were normal. Intestinal biopsy revealed subtotal villous atrophy. Patient was prescribed gluten-free diet, to which she responded with alleviation of symptoms.
  
  
  CONCLUSIONS
  Negative serology should not rule out celiac disease; intestinal biopsy should be performed if there is strong clinical suspicion.
authors.affiliation: Department of Surgery, The Aga Khan University Hospital (Stadium Road), Karachi (74800), Pakistan. mehreen_adhi@yahoo.com
authors.forename: Mehreen
authors.initials: M
authors.lastname: Adhi
authors.forename: Asma
authors.initials: A
authors.lastname: Farooq
authors.forename: Syed Ali
authors.initials: SA
authors.lastname: Hamid
authors.forename: Rabia
authors.initials: R
authors.lastname: Hasan
authors.forename: Salman
authors.initials: S
authors.lastname: Mamji
authors.forename: Akhtar Ali
authors.initials: AA
authors.lastname: Baloch