Journal of Gastrointestinal & Digestive System
Open Access

Case Report

Diarrhea and Symptomatic Coagulopathy: An Uncommon Presentation of Celiac Disease

Marta Eusébio^1*, Paulo Caldeira¹, Carlos Cabrita², André Ramos¹, Jesús Cadillá³ and Horácio Guerreiro¹

¹Gastroenterology Departament, Centro Hospitalar do Algarve, EPE, Rua Leão Penedo, 8000-386 Faro, Portugal

²Internal Medicine Department, Centro Hospitalar do Algarve, EPE, Rua Leão Penedo, 8000-386 Faro, Portugal

³Pathology Department, Centro Hospitalar do Algarve, EPE, Rua Leão Penedo, 8000-386 Faro, Portugal

*Corresponding Author:

Marta Soares dos Santos Eusébio
Gastroenterology Department
Centro Hospitalar do Algarve EPE, Rua Leão Penedo
8000-386 Faro, Portugal
Tel: +351 919186736
E-mail: martaeusebio@gmail.com

Received date: November 19, 2015, Accepted date: December 1, 2015, Published date: December 08, 2015

Citation: Eusébio M, Caldeira P, Cabrita C, Ramos A, Cadillá J, et al. (2015) Diarrhea and Symptomatic Coagulopathy: An Uncommon Presentation of Celiac Disease. J Gastrointest Dig Syst 5:358. doi:10.4172/2161-069X.1000358

Copyright:© 2015 Eusebio M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

A 39 year-old female was admitted to the emergency department due to watery diarrhea and weight loss for 3 weeks. Over the last days she also presented menorrhagia and vomiting. Physical examination revealed skin paleness and slight dehydration. Laboratory investigation showed microcytic anemia (hemoglobin 10,6 g/dL), multiple nutricional deficiencies and hypertransaminasemia (aspartate aminotransferase 120 UI/L and alanine aminotransferase 201 UI/L). International normalized ratio was greatly increased (11,87: more than 10 times the upper limit of normal) as well as activated partial thromboplastin time (100 seconds). Additional studies were positive for increased antitissue transglutaminase (above 300 UA/mL) and attenuation of duodenal villous pattern on upper endoscopy. Duodenal biopsies confirmed celiac disease. Coagulopathy was treated with vitamin K intravenously with normalization of coagulation assays. Following a gluten-free diet the patient became asymptomatic with no bleeding recurrence and achieved laboratory and histological recovery. Despite being a well-characterized disorder, celiac disease remains under diagnosed. This case highlights the several manifestations of celiac disease that may trigger the diagnosis. Furthermore, bleeding due to vitamin K malabsorption is a rare complication of the disease and is herein presented.

Keywords