Virtual serological uncertainty in a severe celiac disease patient

Authors present the case of a 23-year-old woman with a history of abdominal discomfort and diarrhea. Her complaints have been showing progression since giving birth to a healthy child one and a half year ago. Previous investigations including GI endoscopies performed abroad did not find the exact diagnosis.

A young, thin, pale and seriously diseased woman was seen on admission. Extremely high INR (>8) requiring FFP transfusion could be detected in the background of the severe bleeding from a venous puncture site. Manifest tetania was due to her low serum Ca levels. Low albumin, magnesium and potassium values must be mentioned as well.

Upper GI endoscopy revealed atrophic mucosa in D2 indicating celiac disease. Histopathological examination of biopsy samples confirmed the diagnosis. Usual serological tests (IgA anti-tissue transglutaminase/TG2/, Anti-endomysium antibodies-IgA/EMA/), were contradictory at first, although deamidated gliadin antibodies (DGP) showed clear positivity. This result may be convincing enough that anti-DGP antibody can still be used as a reliable serological marker in the diagnosis of celiac disease.

After administering proper supportive treatment and introducing gluten free diet our patient improved quickly and became asymptomatic.