A Rare Association of Silent Celiac Disease, Acute Hepatitis and Aplastic Anemia: Case Report and Review of Literature

Abstract

Liver abnormalities are common extra-intestinal manifestations of celiac disease (CD). However, aplastic anemia had been rarely described in this disorder. Here, we report an exceptional case suggesting a rare association between asymptomatic CD, acute hepatitis and aplastic anemia: A Nine-year old girl presented with jaundice of 3 weeks duration and hepatosplenomegaly on physical exam. Investigations revealed an acute liver disorder with high serum transaminases levels. Extensive investigations excluded infectious, metabolic and auto immune as cause of acute liver disease. A celiac disease was diagnosed according to the histological exam of small bowel biopsy. A reversal of hepatic disorder was observed within 2 months after the initiation of Gluten free diet. However, the child developed aplastic anemia, which dramatically worsened despite immunosuppressive therapy. The etiological assessment of aplastic anemia was negative suggesting an association with hepatitis and silent celiac disease that could be explained by a common underlying immune pathological mechanism. Therefore, a screening of CD in acute liver disorder and AA should been considered by clinicians.