title: An autoimmune disease refractory to immunosuppressive regimens: celiac disease diagnosed long after liver transplantation.
abstract: CD is defined as T-lymphocyte-mediated gluten sensitivity. Although CD is known to affect the small intestine, it is nonetheless a multisystem disorder. Liver involvement in CD may vary from isolated hypertransaminasemia to cirrhosis. Because CD is an inappropriate immune response to gluten proteins, strict gluten-free diet is the principal therapy, along with management of liver dysfunction. In patients who fail to respond to a gluten-free diet, immunosuppressive drugs may improve intestinal inflammatory activity in untreated CD. The present case report is of a 25-yr-old woman with diarrhea lasting several weeks. The patient had received a liver transplant 13 yr earlier, and presented with cryptogenic cirrhosis diagnosed as CD. This appears to be the first case of its kind in which a pediatric long-term liver transplant patient presents with diarrhea eventually diagnosed as CD whose diet included gluten, and who was treated by an immunosuppressive drug regimen. Because of the normalization of CD-related antibodies in the post-transplantation period without gluten restriction, CD should be part of a list of diagnostic possibilities in liver transplant patients presenting with diarrhea of unknown etiology.
authors: Department of Pediatric Gastroenterology, Hepatology and Nutrition, Ege University Faculty of Medicine, Izmir, Turkey.
authors: Çiğdem
authors: Ç
authors: Ecevit
authors: Miray
authors: M
authors: Karakoyun
authors: Fatih
authors: F
authors: Ünal
authors: Hasan A
authors: HA
authors: Yüksekkaya
authors: Başak
authors: B
authors: Doğanavşargil
authors: Raşit V
authors: RV
authors: Yağcı
authors: Sema
authors: S
authors: Aydoğdu
mesh_terms: D000328:Adult; D001327:Autoimmune Diseases / Q000150:complications* / Q000276:immunology*; D002446:Celiac Disease / Q000150:complications / Q000175:diagnosis* / Q000209:etiology*; D003967:Diarrhea / Q000209:etiology; D055050:Diet, Gluten-Free; D004724:Endoscopy; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007249:Inflammation; D008103:Liver Cirrhosis / Q000151:congenital / Q000209:etiology / Q000628:therapy; D008107:Liver Diseases / Q000150:complications / Q000628:therapy; D016031:Liver Transplantation / Q000009:adverse effects*; D013997:Time Factors
chemical_list: D007166:Immunosuppressive Agents
keywords: celiac disease; immunosuppressive therapy; liver transplantation