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Factitious diarrhea masquerading as refractory celiac disease
Rajesh N Keswani1, Jenny Sauk, Sunanda V Kane
1Section of Gastroenterology, University of Chicago Hospitals, and Department of Internal Medicine, University of Chicago Hospitals, Chicago, IL 60637, USA. rkeswani@medicine.bsd.uchicago.edu
Southern Medical Journal
|March 24, 2006
Summary
Refractory celiac disease can be caused by laxative abuse, even with a confirmed diagnosis. This case emphasizes considering factitious diarrhea in persistent cases, regardless of underlying conditions.
Area of Science:
- Gastroenterology
- Internal Medicine
Background:
- Celiac disease is an autoimmune disorder triggered by gluten ingestion.
- Refractory celiac disease (RCD) is diagnosed when symptoms persist despite a strict gluten-free diet.
Observation:
- A 23-year-old female with diagnosed celiac disease presented with refractory symptoms requiring evaluation for immunosuppressive therapy.
- Diagnostic workup revealed an elevated fecal magnesium level.
- Further investigation confirmed concurrent laxative abuse.
Findings:
- Elevated fecal magnesium levels can be indicative of laxative abuse.
- Laxative abuse can mimic or exacerbate symptoms of refractory celiac disease.
Implications:
- Clinicians should consider factitious diarrhea, specifically laxative abuse, in patients with refractory celiac disease.
- A comprehensive diagnostic approach is crucial, even in the presence of established autoimmune conditions.
- Identifying and addressing laxative abuse is essential for effective management and avoiding unnecessary immunosuppressive therapies.