Duhring Brocq Disease: The First Manifestation of Celiac Disease in an Adolescent

Abstract

Dermatitis herpetiformis (Duhring Brocq disease) is an autoimmune inflammatory disease determining polymoprhic pruriginous lesions. It is always associated with a gluten sensitive enteropathy which is most frequently clinically silent. The diagnosis is made on the basis of clinical, serological (IgA antitransglutaminase antibodies and antiendomysial antibodies), hystological and immunollogical (granular immunglobulin A deposits in the papilarry dermis by direct immunofluorescence) data. We present the case of an adolescent with dermatitis herpetiformis associated with atypical celiac disease. The particularity of the case was the abscence of other celiac disease manifestations and the finding of a cutaneous abscess infected with Staphiloccocus aureus, facilitated by the excoriated lesions caused by scratching, which was afterwards complicated with septic arthritis. After 6 weeks of gluten-free diet the cutaneous lesions dissapeared and the pruritus diminished.