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Palermo April 2014

Palermo April 2014

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Palermo April 2014

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  1. PalermoApril 2014 VirtutVelmishi

  2. AMBRA18 months

  3. Brief story • First Child • Normal pregnancy • Birthweight= 3kg • Exclusive breastfeeding for 6 months • Complementaryfoodsafterthisperiod • Until 12 monthseverything ok

  4. Problems • Chronicdiarrhea • Malnutrition • Failure to thrive • 2 hospitalisations • Dermatitis ( treatedseveral times by dermatologist)

  5. Lab WBC=12000; RBC=5.080.000;HGB=7.7g/dl; PLT=358000 Urinary analisis = normal albuminemia=1,9 AST=123 U/L ALT=88 U/L IgA anti TTG> 100 UI /ml TotaleIgA =normal Weight=7,5 kg(-2,5DS) Height=79cm(-2DS)

  6. Hypoproteinemicedema

  7. dermatitisherpetiforme

  8. dermatitisherpetiforme

  9. Gluten free diet

  10. Fiqerete16 MONTHS OLD

  11. Brief story • First child • Birth weight =3400 g • Normal pregnancy, normal delivery • Exclusive breast fed first month • After she is fed by formula milk • 3 ½ month supplemental foods ( gluten also) • 2 hospitalizations: - 2 months : respiratory infection - 4 months : acute gastroenteritis • No familiary disease

  12. Four months ago( 12 month old)Chronic diarrheaFailure to thrive Vomiting

  13. Lab • WBC=12000; RBC=5.080.000;HGB=9.7g/dl; PLT=358000 • Urinary analisis = normal IgA anti DPG=107 u/ml Total IgA=normal TotaleIgA=108 u/ml

  14. Duodenal biopsy

  15. Biopsy Marsh 3 C

  16. Gluten free diet

  17. Growth chart

  18. But ....two weeks ago • Polyuria • Polydipsia • Glycaemia=459 mg/dl • Ketonuria= +++++ • Kussmal respiration • Ph=7.1; HCO3= 4.4 ; HbA1C = 7.4

  19. Second diagnosis • Diabetic ketoacidosis Coeliac disease association: T1DM

  20. ConclusionS • …some authors hypothized that in genetically susceptible patients one disease could predispose to another • … in patients with T1D, diabetes is usually diagnosed first, CD precedes diabetes onset only in 10-25%