Тяжелое течение целиакии, осложненной стрессовой гипергликемией

Abstract

This article presents a clinical case of lately diagnosed celiac disease complicated by stress-induced hyperglycemia. A 2-yearold patient was admitted to the intensive care unit of the Republican Specialized Scientific and Practical Medical Center of Pediatrics with severe protein-energy malnutrition, lethargy, abdominal bloating, and constipation. On admission, the child had hypoproteinemia, hypoalbuminemia, blood glucose levels up to 11.7 mmol/L, and anemia. On the third day of illness, blood glucose levels reached 16 mmol/L, which was considered as stress-induced hyperglycemia. Glucose levels were reduced by insulin injections on day 9. Celiac disease was suspected based on complaints, anamnestic, clinical and laboratory findings. Examination revealed elevated levels of IgA antibodies to tissue transglutaminase, exceeding the reference values 15 times. Genetic study confirmed the presence of predisposition to the disease. Catamnestic follow-up demonstrated a positive effect of a gluten-free diet. This is the first description of a typical form of celiac disease with late diagnosis and complications such as stress-induced hyperglycemia, respiratory failure, protein-energy malnutrition, and protein-losing enteropathy. Early diagnosis is very important to prevent long-term complications. Key words: children, malabsorption, celiac disease, stress hyperglycemia, protein-losing enteropathy