title: Celiac Disease Presenting as Profound Diarrhea and Weight Loss - A Celiac Crisis.
abstract: BACKGROUND Celiac disease is a hypersensitivity enteropathy that can have various presentations in adults. Rarely, patients can present with severe lab abnormalities, dehydration and weight loss caused by celiac disease - a celiac crisis. CASE REPORT A 46-year-old male with a past medical history significant for diabetes mellitus, type 2 (DM2) and recently treated Bell's Palsy presented to the emergency room complaining of weakness, diarrhea and lightheadedness. On presentation, the patient had a systolic blood pressure (SBP) of 60 mm Hg and a lactic acidosis with pH of 7.28. Infectious etiologies of diarrhea were ruled out. The patient had an EGD which showed erythema of the duodenal bulb. Serum anti-gliadin and anti-TTG IgA were both elevated suggesting Celiac disease. Biopsies showed histopathology consistent with celiac disease. The patient's diarrhea resolved after initiation of a gluten free diet. He gained 25 kilograms after discharge and did not require further hospitalizations for diarrhea. CONCLUSIONS Celiac crisis is a very rare presentation of celiac disease in adults but nonetheless should be considered in patients with marked metabolic derangements in the setting of osmotic diarrhea. Treatment consists of a gluten free diet and may require management with steroids and total parenteral nutrition (TPN).
authors: Department of Internal Medicine, University of Illinois - Chicago, Chicago, IL, USA.
authors: Vadim
authors: V
authors: Bul
authors: Department of Gastroenterology, University of Illinois - Chicago, Chicago, IL, USA.
authors: Brett
authors: B
authors: Sleesman
authors: Department of Gastroenterology, University of Illinois - Chicago, Chicago, IL, USA.
authors: Brian
authors: B
authors: Boulay
mesh_terms: D002446:Celiac Disease / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D003967:Diarrhea / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015431:Weight Loss