[Monosymptomatic endemic sprue as a cause of iron deficiency anemia]

For about two years a 23-year-old woman, without symptoms and of normal weight, had been known to have an iron deficiency anaemia (Hb 56 g/l; after oral iron substitution 100 g/l; mean corpuscular volume 66.7 fl, ferritin 5.0 micrograms/l). Gynaecological examination was normal. Radiography of the small intestine revealed coarse rugal pattern of the duodenum. Endoscopically obtained duodenal biopsy demonstrated villous atrophy. Elevated anti-gliadin antibody titres (IgG 49.9 U, IgA 52.3 U), as well as the response to a gluten-free diet confirmed the diagnosis of monosymptomatic coeliac disease. Although anaemia is one of the characteristic features of coeliac disease, it is rare as the only sign. The risk of delayed diagnosis is especially high in women before menopause.