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Case presentation

Case presentation. 23 Feb. 2018. A 21 years old woman CC: jaundice since 1 month ago, nausea, anorexia, vertigo PMH: admission 15 years ago(??) DH: Neg HH: Neg FH: Cardiac disease in her father and sister. Physical examination. Conscious and aware Icterus in sclera BP= 110/80 HR=88

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Case presentation

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  1. Case presentation 23 Feb. 2018

  2. A 21 years old woman CC: jaundice since 1 month ago, nausea, anorexia, vertigo PMH: admission 15 years ago(??) DH: Neg HH: Neg FH: Cardiac disease in her father and sister

  3. Physical examination • Conscious and aware • Icterus in sclera • BP= 110/80 • HR=88 • RR=14 • O2s=90% • AT=36.8

  4. Physical examination • Head and neck : No LAP ,high JVP and thyromegaly • Lung: clear • Heart: normal • Abdomen :Not distant and tender ,Murphy sign was negative, No organomegaly • Extremities: Normal • Neurologic: Normal

  5. Lab test • HBS Ag=Neg • HCV Ab=Neg • HBC Ab=Neg • HAV AB= Neg • HEV Ab= Neg • LDH=434 • TSH=2.2 • SPEP=Nl • Fe=242 • TIBC=424 • Ferritin= 92.1 • TS=57% • AMA=Neg • ASMA=Neg • Anti LKM Ab=Neg

  6. Lab test • ANA=1/160 (Pos) • Anti TTG Ab=94 (Pos) • Serum IgA=Nl • Ceruloplasmin =75( 15-60) • IgG4=1127 (62-1127)

  7. Sono: Stone in GB: 14 mm • MRCP: Stone in GB: 13 mm- Normal CBD

  8. Liver Biopsy

  9. Celiac • 10-40 years old • 10-15 % risk in first degree • Associated conditions: dermatitis herpetiformis, down syndrome, selective IgA deficiency, other autoimmune features : DM type 1, thyroid disease, liver disease, atopic dermatitis, other allergies

  10. Classic: diarrhea, malabsorption, growth failure, weight loss, anemia, neurologic disorder, • Atypical symptoms: fatigue, iron deficiency, unexplained elevation of serum aminotransferase

  11. Celiac disease Villous atrophy, malabsorption, resolution of the mucosal lesion and symptoms upon withdrawal of gluten containing foods, within a few weeks to months

  12. Atypical celiac disease Minor GI complaints, anemia, osteoporosis arthritis, increased LFT,…

  13. Latent celiac disease: • Celiac disease was present before usually in childhood, recovered on diet, and remaining silent even with normal diet. • A normal mucosa on earlier normal diet, but celiac disease developed later

  14. Diagnosis:

  15. Asymptomatic (silent) celiac disease: Recognized incidentally based upon screening for Ab against gliadin or TTG

  16. Treatment • Gluten free diet • Vit A, D, E, B12 , copper, zinc, carotene, folic acid, ferritin, iron, thiamin, B6, magnesium, selenium • Bone loss • Pneumocoocal vaccination(hyposplenism)

  17. Follow up • Clinical • Serologic • D2 biopsy on failed treatment

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