P1553 - An Unusual Presentation of Celiac Disease in an Adult as Celiac Crisis

Nazli Begum Ozturk, MD¹, Nishant Aggarwal, MD², Rama Mouhaffel, MD³, Fnu Vikash, MD, M.Med⁴, Raim Iliaz, MD^5
1Corewell Health William Beaumont University Hospital, Royal Oak, MI; ²Beaumont Health, Royal Oak, MI; ³Banner - University of Arizona, Tucson, AZ; ⁴Albert Einstein College of Medicine, New York, NY; ⁵Atlas University, Istanbul, Istanbul, Turkey

Introduction: Celiac crisis is an uncommon but potentially life-threatening manifestation of celiac disease characterized by sudden onset of profuse diarrhea with severe metabolic abnormalities. In this report, we present an adult patient with celiac crisis.

Case Description/Methods: A 56-year-old male with history of diabetes mellitus and hypertension presented with one month history of bloody diarrhea with 5-6 bowel movements a day. He has presented to multiple hospitals and received antibiotic treatments, and as his symptoms have been persistent, he presented to our hospital. On presentation, he was afebrile, his blood pressure was 110/70 mmHg, heart rate was 72 bmp, and SpO2 at 97% on room air. Physical examination was remarkable for dry mucous membranes and hyperactive bowel sounds. No tenderness to palpation was present on abdominal exam. Laboratory workup was remarkable for hemoglobin at 9.1 g/dL (14-17.5 g/dL), MCV at 66.8 mm3 (80-96 mm3), WBC at 9.22 x103/mL (4.4-11.4 x103/mL, 64% neutrophils, 28% lymphocytes), platelets at 391 x109/L (150-450 x109/L), CRP at 1.33 mg/L (0-5 mg/L), AST: 34.7 U/L (< 35 U/L), ALT: 53.9 (8-37 U/L), creatinine 0.6 (0.5-1.1 mg/dL), phosphorus at 0.93 mg/dl (2.7-4.5 mg/dl), potassium at 2.33 mmol/L (3.5-5.1 mmol/L). Venous blood gas pH at 7.1 (7.32-7.43). Ferritin was 12.40 ng/mL (30-400 ng/mL), iron: 18.9 mcg/dL (59-158 mcg/dL). Stool culture, C. difficile and E. histolytica were negative. HIV 1/2 tests were negative. Anti-endomysium and tissue transglutaminase IgA were positive. An EGD and colonoscopy were performed with findings of normal esophagus, gastric fundus and body, and gastric antrum was hyperemic. Duodenum was notable for scalloped duodenal folds and edematous appearance. Multiple biopsies were obtained from duodenum with findings consistent with gluten enteropathy and complete villous atrophy (Marsh type 3c). H. pylori was negative on gastric biopsies. IV fluids and electrolyte supplementations for K, Mg, and P were started and the patient’s symptoms have remarkably improved. IV iron was started. Gluten-free diet was initiated and the patient was discharged after clinical and laboratory improvements.

Discussion: The clinical manifestations of celiac disease can vary from asymptomatic presentations to life-threatening such as celiac crisis. Severe acute onset of celiac crisis is very rarely seen in adults. In adults with profuse diarrhea and metabolic abnormalities, celiac disease should be considered as a differential diagnosis.


Disclosures:


Nazli Begum Ozturk, MD¹, Nishant Aggarwal, MD², Rama Mouhaffel, MD³, Fnu Vikash, MD, M.Med⁴, Raim Iliaz, MD⁵. P1553 - An Unusual Presentation of Celiac Disease in an Adult as Celiac Crisis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.