An uncommon diagnosis of celiac disease in a thalassemic girl

Abstract

s / Digestive and Liver Disease 46 (2014) e85–e127 e117 AN UNCOMMON DIAGNOSIS OF CELIAC DISEASE IN A THALASSEMIC GIRL Monica Montuori1,∗, Maria Paola Smacchia2, Donatella Iorfida1, Stefania Leoni1, Chiara Maria Trovato1, Silvia Gatti 1, Ilaria Celletti 1, Francesco Valitutti 1, Michela Capogna2, Caterina Anania1, Salvatore Cucchiara1 1 UOC Gastroenterologia ed Epatologia Pediatrica, Sapienza Universita di Roma, Roma, Italy 2 Presidio Regionale Malattie Ereditarie, Sapienza-Universita di Roma, Roma, Italy Celiac disease (CD) has a heterogeneous clinical expression. This report describes an uncommon CD diagnosis in a 21 year old girl, affected by thalassemia major and followed at our Hematology Unit. Her ferritin levels used to range between 700 and 1000 g/L when she was on deferoxamine (40mg/kg/day s.c.), therefore replaced with deferosilax (30–40mg/kg/day per os) with stabilization of values around 400 g/L. After EBV infection, recurrent abdominal pains and diarrhea appeared. Few months later, ferritin levels decreased stepwise to 120 g/L albeit the same daily iron intake (blood transfusions) and the same drug dose, leading hematologists to reduce deferosilax up to 13mg/kg/day. Her values increased up to 300 g/L. Thereafter, she was sent at our Gastroenterology and Hepatology Unit because of persisting gastrointestinal symptoms. Screening for CD showed anti-transglutaminase IgA>100UA/mL (<16) and positive antiendomysial antibodies. A reduction in number and height of foldswas found in bulb and duodenum at upper gastrointestinal endoscopy and histological examination confirmed CD diagnosis (MarshOberhuber 3a-3b). Once on gluten-free diet (GFD) ferritin levels rose to 568 g/L, thus requiring to increase deferosilax dose. This report suggests to consider undiagnosedCD in thalassemic patients when ferritin levels unexpectedly decrease demanding a lower iron chelator dose, perhaps due to un underlying malabsorption. Although the GFD leads to increased ferritin levels, it remains essential in order to prevent the risk of CD complication in organs such as liver, pancreas, thyroid, bone and heart, already potentially damaged by hematological condition. http://dx.doi.org/10.1016/j.dld.2014.07.138 A CASE OF ASYMPTOMATIC GASTRITIS NODULAR HP-RELATED AND COELIAC DISEASE Elvira Difrancisca ∗, Maria Letizia Lospalluti, Giuseppe Iacono Azienda Ospedaliera di Rilievo Nazionale ad Alta SpecializzazioneCivico, G. Di Cristina Benfratelli,