title: Reversal of IgM deficiency following a gluten-free diet in seronegative celiac disease.
abstract: Selective IgM deficiency (sIGMD) is very rare; it may be associated with celiac disease (CD). We present the case of an 18-year-old man with sIGMD masking seronegative CD. Symptoms included abdominal pain, diarrhea and weight loss. Laboratory tests showed reduced IgM, DQ2-HLA and negative anti-transglutaminase. Villous atrophy and diffuse immature lymphocytes were observed at histology. Tissue transglutaminase mRNA mucosal levels showed a 6-fold increase. The patient was treated with a gluten-free diet (GFD) and six months later the symptoms had disappeared, the villous architecture was restored and mucosal tissue transglutaminase mRNA was comparable to that of healthy subjects. After 1 year of GFD, a complete restoration of normal IgM values was observed and duodenal biopsy showed a reduction of immature lymphocytes and normal appearance of mature immune cells.
authors.affiliation: Lucia Montenegro, Domenico Piscitelli, Floriana Giorgio, Claudia Covelli, Maria Grazia Fiore, Giuseppe Losurdo, Andrea Iannone, Enzo Ierardi, Alfredo Di Leo, Mariabeatrice Principi, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Montenegro
authors.affiliation: Lucia Montenegro, Domenico Piscitelli, Floriana Giorgio, Claudia Covelli, Maria Grazia Fiore, Giuseppe Losurdo, Andrea Iannone, Enzo Ierardi, Alfredo Di Leo, Mariabeatrice Principi, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Piscitelli
authors.affiliation: Lucia Montenegro, Domenico Piscitelli, Floriana Giorgio, Claudia Covelli, Maria Grazia Fiore, Giuseppe Losurdo, Andrea Iannone, Enzo Ierardi, Alfredo Di Leo, Mariabeatrice Principi, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy.
authors.forename: Floriana
authors.initials: F
authors.lastname: Giorgio
authors.affiliation: Lucia Montenegro, Domenico Piscitelli, Floriana Giorgio, Claudia Covelli, Maria Grazia Fiore, Giuseppe Losurdo, Andrea Iannone, Enzo Ierardi, Alfredo Di Leo, Mariabeatrice Principi, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Covelli
authors.affiliation: Lucia Montenegro, Domenico Piscitelli, Floriana Giorgio, Claudia Covelli, Maria Grazia Fiore, Giuseppe Losurdo, Andrea Iannone, Enzo Ierardi, Alfredo Di Leo, Mariabeatrice Principi, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy.
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Fiore
authors.affiliation: Lucia Montenegro, Domenico Piscitelli, Floriana Giorgio, Claudia Covelli, Maria Grazia Fiore, Giuseppe Losurdo, Andrea Iannone, Enzo Ierardi, Alfredo Di Leo, Mariabeatrice Principi, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Losurdo
authors.affiliation: Lucia Montenegro, Domenico Piscitelli, Floriana Giorgio, Claudia Covelli, Maria Grazia Fiore, Giuseppe Losurdo, Andrea Iannone, Enzo Ierardi, Alfredo Di Leo, Mariabeatrice Principi, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Iannone
authors.affiliation: Lucia Montenegro, Domenico Piscitelli, Floriana Giorgio, Claudia Covelli, Maria Grazia Fiore, Giuseppe Losurdo, Andrea Iannone, Enzo Ierardi, Alfredo Di Leo, Mariabeatrice Principi, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy.
authors.forename: Enzo
authors.initials: E
authors.lastname: Ierardi
authors.affiliation: Lucia Montenegro, Domenico Piscitelli, Floriana Giorgio, Claudia Covelli, Maria Grazia Fiore, Giuseppe Losurdo, Andrea Iannone, Enzo Ierardi, Alfredo Di Leo, Mariabeatrice Principi, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Di Leo
authors.affiliation: Lucia Montenegro, Domenico Piscitelli, Floriana Giorgio, Claudia Covelli, Maria Grazia Fiore, Giuseppe Losurdo, Andrea Iannone, Enzo Ierardi, Alfredo Di Leo, Mariabeatrice Principi, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy.
authors.forename: Mariabeatrice
authors.initials: M
authors.lastname: Principi
mesh_terms: D000293:Adolescent; D001284:Atrophy; D001323:Autoantibodies / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D002446:Celiac Disease / Q000097:blood / Q000175:diagnosis / Q000178:diet therapy* / Q000235:genetics / Q000276:immunology; D055050:Diet, Gluten-Free; D004386:Duodenum / Q000276:immunology* / Q000473:pathology; D019204:GTP-Binding Proteins / Q000235:genetics / Q000276:immunology*; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood / Q000172:deficiency*; D007150:Immunohistochemistry; D007413:Intestinal Mucosa / Q000276:immunology* / Q000473:pathology; D008297:Male; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D012333:RNA, Messenger / Q000032:analysis; D011503:Transglutaminases / Q000235:genetics / Q000276:immunology*; D016896:Treatment Outcome
chemical_list: D001323:Autoantibodies; D015415:Biomarkers; D007075:Immunoglobulin M; D012333:RNA, Messenger; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins
keywords: Gluten-free diet; Selective IgM deficiency; Seronegative celiac disease; Tissue transglutaminase