Postpartum Onset of Adult Celiac Disease in Identical Twin Sisters

Different risk factors for the onset of celiac disease have been enumerated, with the single most important factor being a known familial history of biopsy-defined disease (1). However, estimated rates of familial celiac disease have been difficult to determine due to the important phenomenon of clinical discordance, even in genetically identical twin pairs (2). In addition, nongenetic factors have been suspected to play a role in the clinical onset of adult celiac disease, including pregnancy and the puerperium (3,4).