title: Severe persistent unremitting dermatitis, chronic diarrhea and hypoalbuminemia in a child; Hartnup disease in setting of celiac disease.
abstract: BACKGROUND
  Celiac disease (CD) is a complex autoimmune disorder that can lead to an inflammatory small intestinal villous atrophy and malabsorption. Hartnup disease is an autosomal recessive disorder caused by increased urinary excretion of neutral amino acids. Co-occurrence of Hartnup disease and CD is extremely rare with only a single case reported.
  
  
  METHODS
  We report a 3-year girl with chronic diarrhea, Hypoalbuminemia and exfoliative erythema. She was diagnosed with celiac disease, which did not improve on gluten free diet. Hartnup disease was suspected and was confirmed by neutral aminoaciduria. Niacin was started and followed by dramatic improvement.
  
  
  CONCLUSIONS
  Presence of Celiac and Hartnup disease in single individual is very rare. Complete nutritional assessment of refractory celiac patient can reveal underlying nutritional deficiency.
authors.affiliation: New York Presbyterian, Weill Cornell Medical College, New York, USA. ciecierega@gmail.com.
authors.forename: Thomas
authors.initials: T
authors.lastname: Ciecierega
authors.affiliation: An-Najah National University, P.O. BOX 7, Nablus, West Bank, Palestine. imaddweikat@yahoo.ca.
authors.forename: Imad
authors.initials: I
authors.lastname: Dweikat
authors.affiliation: Makassed Hospital, Alquds University, Medical College, Jerusalem, Palestine. moh_4u4ever@yahoo.com.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Awar
authors.affiliation: Makassed Hospital, Alquds University, Medical College, Jerusalem, Palestine. mr_shahrour@hotmail.com.
authors.forename: Maher
authors.initials: M
authors.lastname: Shahrour
authors.affiliation: Makassed Hospital, Alquds University, Medical College, Jerusalem, Palestine. drbassam@hotmail.com.
authors.forename: Bassam Abu
authors.initials: BA
authors.lastname: Libdeh
authors.affiliation: Makassed Hospital, Alquds University, Medical College, Jerusalem, Palestine. drmutazsultan@gmail.com.
authors.forename: Mutaz
authors.initials: M
authors.lastname: Sultan
mesh_terms: D002446:Celiac Disease / Q000150:complications*; D002675:Child, Preschool; D002908:Chronic Disease; D003873:Dermatitis, Exfoliative / Q000209:etiology*; D003967:Diarrhea / Q000209:etiology*; D004890:Erythema / Q000209:etiology; D005260:Female; D006250:Hartnup Disease / Q000150:complications*; D006801:Humans; D034141:Hypoalbuminemia / Q000209:etiology*; D009525:Niacin / Q000172:deficiency / Q000627:therapeutic use; D014803:Vitamin B Complex / Q000627:therapeutic use
chemical_list: D014803:Vitamin B Complex; D009525:Niacin