A Case of Polyautoimmunity: Celiac Hepatitis, Grave's Disease and Autoimmune Hemolytic Anemia

J Coll Physicians Surg Pak. 2019 Dec;29(12):S106-S108. doi: 10.29271/jcpsp.2019.12.S106.

Abstract

Celiac disease (CD) is an autoimmune disorder with high incidence of multi organ involvement; especially, gastrointestinal manifestations and an increased risk of malignancies. Here we report a case of CD with celiac hepatitis, autoimmune hemolytic anemia (AIHA) and Grave's disease (GD) with their complications. Polyautoimmunity requires comprehensive analysis. While CD and GD were previously diagnosed, AIHA and cirrhosis were diagnosed during admission upon extensive work-up. Similarly, other autoimmune etiologies, such as autoimmune hepatitis (AIH), and/or primary biliary cholangitis were ruled out. All three diseases were treated afresh with strict adherence to a gluten-free diet (GFD) and carbimazole along with addition of medications for cirrhosis complicated by ascites. This was a rare case where non-adherence to a GFD led to such severe adverse events. A case of celiac hepatitis presenting with such a wide array of signs and symptoms has rarely been reported in the literature and the management of this patient was unique and challenging.

Publication types

  • Case Reports

MeSH terms

  • Anemia, Hemolytic, Autoimmune / complications*
  • Anemia, Hemolytic, Autoimmune / immunology
  • Anemia, Hemolytic, Autoimmune / therapy
  • Antithyroid Agents / therapeutic use
  • Autoimmunity*
  • Biopsy
  • Carbimazole / therapeutic use*
  • Celiac Disease / complications*
  • Celiac Disease / immunology
  • Celiac Disease / therapy
  • Diet, Gluten-Free / methods*
  • Female
  • Graves Disease / complications*
  • Graves Disease / immunology
  • Graves Disease / therapy
  • Hepatitis, Autoimmune / complications*
  • Hepatitis, Autoimmune / immunology
  • Hepatitis, Autoimmune / therapy
  • Humans
  • Young Adult

Substances

  • Antithyroid Agents
  • Carbimazole