Onbaşı Karabağ Ş., Keçici R., Aksoy B., Kahveci S., Güler S., Çağan Appak Y., ...More
Pediatric Academic Case Reports, vol.3, no.2, pp.19-23, 2024 (Peer-Reviewed Journal)
Abstract
Celiac disease (CD) may present with different clinical manifestations, and very rarely, it may present with Celiac crisis, which is a fatal complication. An 18-month-old girl was referred to our center due to recurrent diarrheal attacks, inability to gain weight, malaise, fever, and poor general condition. It was learned that the patient, who was followed up in the intensive care unit during his last hospitalization, was examined for the etiology of chronic diarrhea. Celiac disease was suspected, and she was administered a short-term gluten-free diet, but no response was received. The patient, who was in a septic state on admission, had anemia, thrombocytopenia, hypocalcemia, hypokalemia, hypomagnesemia, high acute phase reactants, direct bilirubinemia, coagulopathy and metabolic acidosis in the examinations. When the electrolyte disorder was corrected, total parenteral nutrition was started, and when the general condition stabilized, enteral nutrition was started. Amino acid-based enteral product was preferred in the diet of the patient who had itchy rashes on his body and who had a history of rash after intake of dairy products, and it was observed that the rashes regressed. Celiac serology was positive in the examinations performed for the etiology of chronic diarrhea. Histopathological examination of the biopsy taken from the duodenum was compatible with "Celiac Disease, Marsh Type 3b." Due to celiac disease, severe electrolyte imbalance, coagulopathy and severe malnutrition findings, it was thought that the patient might have celiac crisis. A gluten-free diet was started. After a gluten-free diet and elimination of dairy products, the patient's diarrhea improved, and weight gain occurred. Celiac crisis poses a diagnostic challenge in patients without a previous diagnosis of CD. Celiac crisis, which is a complication of celiac disease with a high mortality, should be considered especially in patients with chronic diarrhea and hyponatremia, hypokalemia, hypoalbuminemia, metabolic acidosis.