iatroX Rounds #5
The clues
- 1
A 32-year-old woman presents with worsening fatigue, abdominal bloating, and intermittent loose stools over the past six months.
- 2
She reports that her stools are often pale, particularly offensive-smelling, and frequently difficult to flush away.
- 3
She has a personal history of type 1 diabetes mellitus and has previously been investigated for persistent iron-deficiency anaemia.
- 4
On examination, she has an intensely itchy, vesicular rash on the extensor surfaces of her elbows and knees.
- 5
Blood tests show a low haemoglobin with a low MCV, and a blood film reveals Howell-Jolly bodies and occasional target cells.
- 6
Serology is positive for IgA tissue transglutaminase antibodies, and a subsequent duodenal biopsy shows subtotal villous atrophy with crypt hyperplasia.
Coeliac disease is an autoimmune-mediated inflammatory condition of the small intestine triggered by the ingestion of gluten in genetically predisposed individuals. It results in a malabsorptive state and carries associations with other autoimmune diseases and specific dermatological manifestations.
- Malabsorption leading to steatorrhoea and iron, folate or B12 deficiency
- Dermatitis herpetiformis is a pathognomonic skin manifestation
- Association with type 1 diabetes and autoimmune thyroid disease
for education and entertainment. not medical advice.