RESUMO
Introduction: Celiac crisis is a life-threatening complication of celiac disease that is rarely described in adults. Case report: We report the case of a 31-year-old man with celiac crisis as a first manifestation of celiac disease. The patient presented with severe diarrhea, metabolic acidosis, and electrolyte disturbances accompanied by electrocardiographic alterations. A satisfactory clinical response was obtained after the correction of electrolyte abnormalities, hydration, and nutritional support with a gluten-free diet according to recommendations for patients at high risk of refeeding syndrome. Discussion: Celiac crisis generally occurs in patients with no previous diagnosis of celiac disease. The physician should therefore be aware of this diagnosis and consider celiac crisis in cases of unexplained intense secretory diarrhea, metabolic acidosis and severe electrolyte alterations in adults. The risk of refeeding syndrome should be assessed when a gluten-free diet is introduced and treatment of celiac crisis should include prevention and management of this possible complication (AU)
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Assuntos
Humanos , Masculino , Adulto , Doença Celíaca/complicações , Doença Celíaca/dietoterapia , Doença Celíaca/diagnóstico , Acidose/complicações , Dieta Livre de Glúten/tendências , Diarreia/complicações , Diarreia/diagnóstico , Diarreia/terapia , Eletrocardiografia/métodos , Fatores de Risco , Eletrólitos/administração & dosagem , Eletrólitos/uso terapêutico , Micronutrientes/uso terapêuticoRESUMO
Background: Celiac disease is described in association with several autoimmune diseases, but rarely with myasthenia gravis. Case report: We describe the case of a 31-year-old white woman with celiac disease who presented manifestations related to a hyperactive immune system, including macroamylasemia, falsepositive anti-HCV, positive antinuclear antibody, and Raynauds phenomenon. The introduction of a gluten-free diet (GFD) resolved these features, but myasthenia gravis (MG) symptoms unexpectedly occurred on that occasion. Discussion: The role of a GFD in the course of autoimmune diseases has been studied and improvement has been reported in many diseases. However, there is no consensus in the literature regarding the course of neurological disorders associated with celiac disease. In the present case, a GFD did not prevent the appearance of symptoms related to myasthenia gravis. There are few reports on the association of celiac disease with myasthenia gravis and therefore little is known about the course and time of onset of myasthenia in celiac patients. The present case increases the knowledge about this unusual autoimmune neurological disease associated with celiac disease (AU)
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