Editors’ note: This case report illustrates that a person can live a long time reporting apparent good health and be completely unaware that they have symptoms of celiac disease. In this case, hematomas, (which are swollen black and blue marks caused by a break in the wall of a blood vessel), that developed on his legs caused the patient to seek medical attention. The ability of his blood to clot was severely impaired and yet there was no other manifestation of hemorrhage.
“Endemic Sprue: Its First Diagnosis Based on Bleeding
Heidinger K, Kemkes-Mathes B, Mathes KJ, Franke F, Voss R, Heckers H
Deutsche medizinische Wochenschrift. 1995 nov 10 Vol. 120 (45), 1543-6
Background: A 47-year old man without previously known illness was admitted to hospital because of acute hematomas in the legs: the history revealed no cause. The pale looking patient reported having large and foul-smelling stools once or twice daily. There were large hematomas and swellings on both legs. His general and nutritional state was reduced. “Bleeding of unknown origin” was suspected at the time.
Investigations: Hemoglobin concentration was 5.6 g/dl, while iron was normal and ferritin reduced. Quick value was below 5%, activated partial thromboplastin time prolonged to 180s. Vitamin A and E concentrations were reduced; coumarin derivatives were not demonstrated in blood. Abdominal ultrasonography showed clearly thickened intestinal walls.
Treatment: Four units of erythrocyte concentration were immediately administered, together with 2000 IU factors II, VII, X and anti-hemophilic factor B, and 10 mg vitamin K intravenously. As intestinal malabsorption was suspected, a vitamin A absorption test was performed: it indicated malabsorption. Upper intestinal endoscopy showed celiac disease, as did a biopsy. The patient’s condition quickly improved after he had been given vitamins D, E and K and put on a gluten-free diet.
Conclusions: Celiac disease can take a clinically unremarkable course for a long time and may finally become manifest through an isolated abnormality, such as bleeding.