Song Min Soo, Farber David, Bitton Alain, Jass Jeremy, Singer Michael, Karpati George
Department of Internal Medicine, McGill University Health Centre, Montreal, Quebec.
Can J Gastroenterol. 2006 Jun;20(6):433-5. doi: 10.1155/2006/574074.
The association between dermatomyositis and celiac disease in children has been well documented. In the adult population, however, the association has not been clearly established. A rare case of concomitant dermatomyositis and celiac disease in a 40-year-old woman is presented. After having been diagnosed with dermatomyositis and iron deficiency anemia, this patient was referred to the gastroenterology clinic to exclude a gastrointestinal malignancy. Blood tests revealed various vitamin deficiencies consistent with malabsorption. The results of gastroscopy with duodenal biopsy were consistent with celiac disease. After she was put on a strict gluten-free diet, both nutritional deficiencies and the dermatomyositis resolved. The patient's human leukocyte antigen haplotype study was positive for DR3 and DQ2, which have been shown to be associated with both juvenile dermatomyositis and celiac disease. It is suggested that patients with newly diagnosed dermatomyositis be investigated for concomitant celiac disease even in the absence of gastrointestinal symptoms.
儿童皮肌炎与乳糜泻之间的关联已有充分记录。然而,在成人中,这种关联尚未明确确立。本文报告了一例40岁女性同时患有皮肌炎和乳糜泻的罕见病例。该患者在被诊断为皮肌炎和缺铁性贫血后,被转诊至胃肠病诊所以排除胃肠道恶性肿瘤。血液检查显示多种维生素缺乏,符合吸收不良。胃镜检查及十二指肠活检结果与乳糜泻相符。在她严格遵循无麸质饮食后,营养缺乏和皮肌炎均得到缓解。患者的人类白细胞抗原单倍型研究显示DR3和DQ2呈阳性,这两种抗原已被证明与青少年皮肌炎和乳糜泻均有关联。建议即使在没有胃肠道症状的情况下,对新诊断的皮肌炎患者进行乳糜泻的相关检查。