Sero-negative celiac disease with dermatitis herpetiformes: a case report.
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.
Adhi
Mehreen
M
Department of Surgery, The Aga Khan University Hospital (Stadium Road), Karachi (74800), Pakistan. mehreen_adhi@yahoo.com
Farooq
Asma
A
Hamid
Syed Ali
SA
Hasan
Rabia
R
Mamji
Salman
S
Baloch
Akhtar Ali
AA