Celiac Crisis - An Acute Presentation of Celiac Disease in an Elderly Female Patient

Celiac disease is also called as non-tropical sprue, celiac sprue, adult celiac disease and gluten sensitive enteropathy. Environmental, immunologic and genetic factors play an important role in the aetiology.1 Symptoms of celiac disease can manifest at any age throughout adulthood. Symptoms range from significant malabsorption of multiple nutrients with diarrhoea, steatorrhea, weight loss and consequences of nutrient depletion (like anaemia and metabolic bone disease). Atypical celiac disease can present with symptoms not related to intestinal malabsorption like neurologic symptoms. Large number of patients with celiac disease can even be asymptomatic. The gold standard in diagnosis of celiac disease is an abnormal small intestinal biopsy and the response of the condition to the elimination of gluten from the diet. Classic changes seen on duodenal /jejunal biopsy 1. An increase in number of intraepithelial lymphocytes 2. Absence or a reduced height of villi 3. A cuboidal appearance and nuclei that are no longer oriented basally in surface epithelial cells 4. Increased numbers of lymphocytes and plasma cells in lamina propria Serology tests for celiac disease: IgA antiendomysial antibody and tissue transglutaminase TG antibodies which when positive is supportive in diagnosis. Acute presentation of celiac disease with severe metabolic derangement in adults is rare and called as “celiac crisis.” 2 In crisis the patient may present with profuse diarrhoea, severe dehydration and metabolic abnormalities, hypokalaemia, hypoalbuminemia, neurologic symptoms and azotaemia. We describe one such case in an elderly female patient.