title: Profound Reversible Hypogammaglobulinemia Caused by Celiac Disease in the Absence of Protein Losing Enteropathy.
abstract: When patients with hypogammaglobulinemia are encountered, a vigorous search should be undertaken for secondary treatable causes. Here we describe the first case of a patient with severe asymptomatic hypogammaglobulinemia where the underlying cause was undiagnosed celiac disease. A strict gluten free diet resulted in resolution of her mild long-standing abdominal symptoms and correction of her hypogammaglobulinemia. There was corresponding improvement in her duodenal histology and normalisation of her celiac serology. Protein losing enteropathy was unlikely to have been the mechanism of her profound hypogammaglobulinemia, as her albumin was within the normal range and she had a normal fecal alpha 1 antitrypsin level. Application of the Ameratunga et al. (2013) diagnostic criteria was helpful in confirming this patient did not have Common Variable Immunodeficiency Disorder (CVID). Celiac disease must now be considered in the differential diagnosis of severe hypogammaglobulinemia. There should be a low threshold for undertaking celiac serology in patients with hypogammaglobulinemia, even if they have minimal symptoms attributable to gut disease.
authors: Department of Clinical Immunology, Auckland Hospital, Park Rd, Grafton, Auckland, 1010, New Zealand. immunology@xtra.co.nz.|Department of Virology and Immunology, Auckland Hospital, Park Rd, Grafton, Auckland, 1010, New Zealand. immunology@xtra.co.nz.
authors: Rohan
authors: R
authors: Ameratunga
authors: Department of Virology and Immunology, Auckland Hospital, Park Rd, Grafton, Auckland, 1010, New Zealand.
authors: Russell William
authors: RW
authors: Barker
authors: Department of Virology and Immunology, Auckland Hospital, Park Rd, Grafton, Auckland, 1010, New Zealand.
authors: Richard Henderson
authors: RH
authors: Steele
authors: Department of Clinical Immunology, Auckland Hospital, Park Rd, Grafton, Auckland, 1010, New Zealand.
authors: Maneka
authors: M
authors: Deo
authors: Department of Virology and Immunology, Auckland Hospital, Park Rd, Grafton, Auckland, 1010, New Zealand.
authors: See-Tarn
authors: ST
authors: Woon
authors: Department of Histopathology, Diagnostic Medlab, Harrison Rd, Ellerslie, Auckland, 1051, New Zealand.
authors: Mee Ling
authors: ML
authors: Yeong
authors: Department of Virology and Immunology, Auckland Hospital, Park Rd, Grafton, Auckland, 1010, New Zealand.
authors: Wikke
authors: W
authors: Koopmans
mesh_terms: D058739:Aberrant Crypt Foci / Q000473:pathology*; D000361:Agammaglobulinemia / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D000818:Animals; D001323:Autoantibodies / Q000097:blood; D001416:Back Pain / Q000209:etiology; D002446:Celiac Disease / Q000175:diagnosis / Q000178:diet therapy / Q000276:immunology*; D055050:Diet, Gluten-Free; D005260:Female; D006965:Hyperplasia; D013601:T-Lymphocytes / Q000276:immunology*; D014612:Vaccines / Q000276:immunology
chemical_list: D001323:Autoantibodies; D014612:Vaccines
keywords: CVID; Celiac disease; hypogammaglobulinemia