Abstract
Celiac disease (CD) is an inflammatory disease of the small intestine. A complete management and differential diagnosis of such disease includes food intolerances, intestinal infections, and irritable bowel syndrome. We describe an 8-years-old adoptive girl from Congo with negative medical history. Patient followed for recurrent abdominal pain and diarrhea associated to Giardia infection, unresponsive to antiparasitic therapy. Persistence of symptoms despite antiparasitic therapy, prompted us to perform: 1- Blood screening of Celiac disease, which was negative; 2- Genetic evaluation of celiac disease, which revealed the presence of HLA-DQ2 heterodimer; and 3- Esophagogastroduodenoscopy, which showed duodenal villous atrophy and crypt hyperplasia, associated with Helicobacter Pylori infection. The child was treated in accordance with international recommendations using a Gluten-free diet and specific antibiotics, which lead to the resolution of the symptoms. Our patient's clinical history seems peculiar, considering that, recurrent Giardiasis may mimic the symptoms of Celiac disease and may simulate clinical and histological picture of active Celiac disease. Early diagnosis may help prevent the complications of untreated celiac disease.
Highlights
Giardia lamblia is one of the most common intestinal parasites in the world, and it contributes to diarrhea and nutritional deficiencies in children in developed regions.Human infection may range from asymptomatic shedding of Giardia lamblia cysts to symptomatic giardiasis, which can present nausea, abdominal pain, acute or chronic diarrhea, malabsorption, and failure to thrive. [1, 2]Celiac disease (CD) is an inflammatory disease of the small intestine with a prevalence of roughly 0.5%-1%
Our patient’s history seems peculiar, considering the confounding factors that delayed the diagnosis of CD: 1- The child being of “Congolese” origin, a Country where infectious diseases are more common than autoimmune inflammatory diseases; 2-The positivity for Giardia in both daughter and mother; 3-The negative serology for CD
(9) Recent studies have shown that Giardiasis can be characterized by a wide range of duodenal abnormalities. [6, 7, 8] Villous atrophy, intraepithelial lymphocytosis, infiltration of the lamina propria by granulocytes, lymphocytes and plasma cells, and nodular lymphoid hyperplasia have all been related to giardiasis. [10]
Summary
Hyppolite K. Tchidjou, [1] Arianna De Matteis, [1] Laura Di Iorio, [1] Andrea Finocchi [1,2] University Department of Pediatrics (DPUO), Children’s Hospital Bambino Gesù, Rome, Italy [1] Chair of Pediatrics, University of Tor-Vergata, Rome, Italy [2]
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