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[Hypertransaminasaemia and impaired liver function in a patient with oligosymptomatic celiac disease]
W P Hofmann1, C F Dietrich, W Holtmeier
1Medizinische Klinik II, Klinikum der Johann-Wolfgang-Goethe-Universität, Frankfurt/Main, Germany.
Insights
Elevated liver enzymes in a patient with celiac disease improved with a gluten-free diet. This case highlights potential liver involvement in celiac disease patients.
Area of Science:
- Gastroenterology
- Hepatology
- Immunology
Background:
- Celiac disease is an autoimmune disorder triggered by gluten ingestion.
- Liver dysfunction can be an extraintestinal manifestation of celiac disease.
- Oligosymptomatic presentation can delay diagnosis.
Observation:
- A 45-year-old man presented with elevated aminotransferases and malabsorption syndrome.
- He had a history of ischemic stroke and subdural hematoma.
- Serological tests revealed IgA antigliadin and IgA antiendomysial antibodies.
Findings:
- Celiac disease was confirmed via endoscopy and duodenal biopsies showing villous atrophy.
- Liver dysfunction and malabsorption symptoms resolved after initiating a gluten-free diet.
- Serum aminotransferase levels normalized within six months.
Implications:
- This case underscores the importance of considering celiac disease in patients with unexplained liver dysfunction.
- Early diagnosis and dietary management can improve both gastrointestinal and hepatic outcomes.
- Further research is warranted to elucidate the mechanisms of liver involvement in celiac disease.
Abstract:
Hypertransaminasaemia and impaired liver function in a patient with oligosymptomatic celiac disease. We describe the case of a 45-year-old man who was referred for evaluation of elevated aminotransferases. One year before referral the patient developed an ischemic stroke followed by a subdural hematoma three months later. In our outpatient clinic the patient presented with a malabsorption syndrome including diminished vitamin-K-dependent clotting factors. Serologic testing was positive for IgA antigliadin antibodies and IgA antiendomysial antibodies. Celiac disease was confirmed by an upper endoscopy examination and biopsies obtained from the distal duodenum. Histological examination showed villous atrophy, crypt hyperplasia and an increase in intraepithelial lymphocyte count consistent with celiac disease. After initiation of a gluten-free diet the malabsorption syndrome as well as liver dysfunction improved. Serum aminotransferase levels normalized within 6 months. The clinical course demonstrates involvement of the liver in patients with celiac disease.