Marked coagulopathy without liver disease or anticoagulation therapy

Area of Science:

• Gastroenterology
• Hematology
• Internal Medicine

Background:

• Celiac disease (CD) is an autoimmune disorder triggered by gluten ingestion, primarily affecting the small intestine.
• While malabsorption is common, symptomatic coagulopathies are rare presentations of CD.

Observation:

• A 66-year-old female presented with severe bleeding symptoms, including ecchymoses and melena, and profound coagulopathy (PTT >200s, PT >150s, INR 20.5).
• Initial investigations revealed severe anemia and vitamin D deficiency, with no evidence of liver disease or anticoagulant use.
• Endoscopic findings showed duodenal mucosal atrophy, gastritis, and villous flattening, with positive transglutaminase serology confirming CD.

Findings:

• The patient's coagulopathy resolved rapidly within two days of treatment with fresh frozen plasma, packed red cells, and intravenous vitamin K.
• Histopathological examination confirmed celiac disease, characterized by villous atrophy and intraepithelial lymphocytes.

Implications:

• This case highlights the critical importance of considering celiac disease in the differential diagnosis of unexplained coagulopathies, even in the absence of typical gastrointestinal symptoms.
• Early identification and management of CD can prevent life-threatening hemorrhagic complications.