Celiac crisis in patients with celiac disease. Case report

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Abstract

Celiac crisis (CC) is a rare life-threatening course of celiac disease, observed mainly in children. In adults, CK can be the first manifestation of the disease and, very rarely, a relapse that occurs in patients who do not follow the gluten-free diet (AGD). Triggers can be stress, surgery, childbirth, etc. A clinical observation of CC developed in a 49-year-old patient with previously established latent celiac disease with subtotal villous atrophy, stage Marsh III C is presented. The patient did not comply with AHD. After severe angina, she developed anorexia, diarrhea, emaciation, coagulopathy, bilateral pulmonary embolism, infarction pneumonia, and enterogenic sepsis. As a result of intensive therapy with prednisolone, Fraxiparine, antibiotics, fresh frozen plasma and strict adherence to hypertension, remission of the disease was achieved.

About the authors

Aleksandra V. Babanova

Loginov Moscow Clinical Research Center

Author for correspondence.
Email: a.babanova@mknc.ru
ORCID iD: 0000-0001-9263-8324

лаборант-исследователь

Russian Federation, Moscow

Larisa M. Krums

Loginov Moscow Clinical Research Center

Email: a.babanova@mknc.ru
ORCID iD: 0000-0003-0692-7133

доктор медицинских наук, старший научный сотрудник, врач-гастроэнтеролог

Russian Federation, Moscow

Svetlana V. Bykova

Loginov Moscow Clinical Research Center

Email: a.babanova@mknc.ru
ORCID iD: 0000-0001-9576-2953

кандидат медицинских наук, врач-гастроэнтеролог, заведующий отделением невоспалительной патологии кишечника

Russian Federation, Moscow

Asfold I. Parfenov

Loginov Moscow Clinical Research Center

Email: a.babanova@mknc.ru
ORCID iD: 0000-0002-9782-4860

доктор медицинских наук, профессор, руководитель отделения патологии кишечника

Russian Federation, Moscow

Galina A. Dudina

Loginov Moscow Clinical Research Center

Email: a.babanova@mknc.ru
ORCID iD: 0000-0001-9673-1067

доктор медицинских наук, врач-гематолог, заведующий гематологическим отделением

Russian Federation, Moscow

Elena A. Sabelnikova

Loginov Moscow Clinical Research Center

Email: a.babanova@mknc.ru
ORCID iD: 0000-0001-7519-2041

доктор медицинских наук, заместитель директора по научной работе

Russian Federation, Moscow

Sergei G. Khomeriki

Loginov Moscow Clinical Research Center

Email: a.babanova@mknc.ru
ORCID iD: 0000-0003-4308-8009

доктор медицинских наук, профессор, руководитель лаборатории патоморфологии

Russian Federation, Moscow

Konstantin A. Lesko

Loginov Moscow Clinical Research Center

Email: a.babanova@mknc.ru
ORCID iD: 0000-0001-9814-0172

кандидат медицинских наук, врач-рентгенолог

Russian Federation, Moscow

Saria R. Dbar

Loginov Moscow Clinical Research Center

Email: a.babanova@mknc.ru
ORCID iD: 0000-0001-6516-7782

младший научный сотрудник врач-гастроэнтеролог

Russian Federation, Moscow

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2. Fig. 1. Histological image of the duodenal mucosa at the initial examination: a – the intestinal villi are absent; crypts are deep; the number of goblet cells in the crypt epithelium is reduced; the lamina propria is heavily infiltrated with lymphocytes and plasma cells, ×120; b – the number of intraepithelial lymphocytes is significantly increased; staining with hematoxylin and eosin, ×300.

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3. Fig. 2. The state of duodenal mucosa at a second examination: a – sings of hyperregenerative atrophy (absence of intestinal villi and deepening of crypts) persist, ×120; b – there is a large number of intraepithelial lymphocytes in the superficial epithelium; staining with hematoxylin and eosin, ×300.

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4. Fig. 3. CT-angiopulmonography: thromboembolism of the branches of the pulmonary artery with the development of infarction pneumonia

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