title: Folate Insufficiency Due to Celiac Disease in a 49-Year-Old Woman of Southeast Asian-Indian Ethnicity.
abstract: The clinical presentation of celiac disease has evolved from chronic diarrhea and malnutrition to mild nutrient insufficiencies. Recently diagnosed adults with celiac disease should be assessed for micronutrient deficiencies because early institution of a gluten-free diet (GFD) prevents morbidity and reduces the incidence of gastrointestinal malignant neoplasms and osteoporosis. In this report, we present the case of a 49-year-old woman of Southeast Asian-Indian descent living in the United States who had folate insufficiency, as manifested by low serum and red blood cell (RBC) folate levels. Further investigation, including serologic testing and intestinal biopsy, confirmed a diagnosis of celiac disease and other nutrient deficiencies. Managing the condition of this patient with folate supplements and implementation of a recommended GFD reversed the folate insufficiency. In conclusion, when serum and/or RBC levels are low in a person of Southeast Asian-Indian descent living in a country with folate fortification of the grain supply, such as the United States, the medical team needs to look for an organic cause, as in our patient, to diagnose and manage celiac disease early and, hopefully, forestall complications.
authors.affiliation: Department of Pathology and Laboratory Medicine.
authors.forename: Ananya
authors.initials: A
authors.lastname: Datta Mitra
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology.
authors.forename: Asha
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Department of Pathology and Laboratory Medicine Division of Endocrinology and Metabolism, University of California Davis Medical Center, Sacramento, CA ijialal@ucdavis.edu.
authors.forename: Ishwarlal
authors.initials: I
authors.lastname: Jialal
mesh_terms: D044466:Asian People; D002446:Celiac Disease / Q000150:complications* / Q000628:therapy; D004032:Diet / Q000379:methods; D005260:Female; D005494:Folic Acid Deficiency / Q000175:diagnosis* / Q000473:pathology* / Q000628:therapy; D006801:Humans; D008875:Middle Aged; D014481:United States
keywords: Southeast Asian Indian; celiac disease; folate insufficiency; gluten free diet; intraepithelial lymphocytes; villous blunting