title: A trichobezoar in a child with undiagnosed celiac disease: a case report.
abstract: Celiac disease is a chronic, immune-mediated enteropathy caused by a permanent sensitivity to ingested gluten cereals that develops in genetically susceptible individuals. The classic presentation of celiac disease includes symptoms of malabsorption but has long been associated with cognitive, emotional, and behavioral disorders. We describe an 8-year-old patient with non-scarring alopecia and diagnosed with trichotillomania. Furthermore, she presented with a 3-year history of poor appetite and two or three annual episodes of mushy, fatty stools. Laboratory investigations showed a normal hemoglobin concentration and a low ferritin level. Serologic studies showed an elevated tissue immunoglobulin G anti-tissue transglutaminase level. A duodenal biopsy showed subtotal villous atrophy and crypt hyperplasia, and a large gastric trichobezoar was found in the stomach. Immediately after beginning a gluten-free diet, complete relief of trichotillomania and trichophagia was achieved. In this report, we describe a behavioral disorder as a primary phenomenon of celiac disease, irrespective of nutritional status.
authors.affiliation: Iñaki Irastorza, Juan Carlos Vitoria, Pediatric Gastroenterology and Nutrition Unit, University Hospital Cruces and School of Medicine, University of the Basque Country, 20018 Bilbao, Basque Country, Spain.
authors.forename: Iñaki
authors.initials: I
authors.lastname: Irastorza
authors.affiliation: Iñaki Irastorza, Juan Carlos Vitoria, Pediatric Gastroenterology and Nutrition Unit, University Hospital Cruces and School of Medicine, University of the Basque Country, 20018 Bilbao, Basque Country, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Tutau
authors.affiliation: Iñaki Irastorza, Juan Carlos Vitoria, Pediatric Gastroenterology and Nutrition Unit, University Hospital Cruces and School of Medicine, University of the Basque Country, 20018 Bilbao, Basque Country, Spain.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Vitoria
mesh_terms: D001630:Bezoars / Q000175:diagnosis / Q000209:etiology*; D002446:Celiac Disease / Q000175:diagnosis* / Q000178:diet therapy / Q000523:psychology; D002648:Child; D002652:Child Behavior; D055050:Diet, Gluten-Free; D004644:Emotions; D005260:Female; D006801:Humans; D013270:Stomach; D016896:Treatment Outcome; D014256:Trichotillomania / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology
keywords: Behavioral disorder; Celiac disease; Malabsorption syndrome; Trichobezoar; Trichotillomania