Diarrhea and Symptomatic Coagulopathy: An Uncommon Presentation of Celiac Disease

Abstract

A 39 year-old female was admitted to the emergency department due to watery diarrhea and weight loss for 3 weeks. Over the last days she also presented menorrhagia and vomiting. Physical examination revealed skin paleness and slight dehydration. Laboratory investigation showed microcytic anemia (hemoglobin 10,6 g/dL), multiple nutricional deficiencies and hypertransaminasemia (aspartate aminotransferase 120 UI/L and alanine aminotransferase 201 UI/L). International normalized ratio was greatly increased (11,87: more than 10 times the upper limit of normal) as well as activated partial thromboplastin time (100 seconds). Additional studies were positive for increased antitissue transglutaminase (above 300 UA/mL) and attenuation of duodenal villous pattern on upper endoscopy. Duodenal biopsies confirmed celiac disease. Coagulopathy was treated with vitamin K intravenously with normalization of coagulation assays. Following a gluten-free diet the patient became asymptomatic with no bleeding recurrence and achieved laboratory and histological recovery. Despite being a well-characterized disorder, celiac disease remains under diagnosed. This case highlights the several manifestations of celiac disease that may trigger the diagnosis. Furthermore, bleeding due to vitamin K malabsorption is a rare complication of the disease and is herein presented.