Maniar Vashishth P, Yadav Sameer S, Gokhale Yojana A
Department of Medicine, Lokmanya Tilak Muncipal Medical College and General Hospital, Sion, Mumbai.
J Assoc Physicians India. 2010 Aug;58:512-5.
Celiac disease (CD) is Gluten sensitive enteropathy with a wide spectrum of severity and protean clinical manifestations. Patients with atypical (non-diarrhoeal) presentations are missed as the diagnosis of Celiac Disease is not considered. We present three young girls (ages 18, 19, 23 at presentation) who were admitted to our hospital as intractable seizures. All had low serum calcium, features of rickets/osteomalacia and anaemia. This prompted us to consider malabsorption due to CD. The diagnosis of CD was confirmed by serologic tests (IgA transglutaminase and IgG antigliadin antibodies) and biopsy of the duodenum. In all patients gluten free diet not only provided drug free control of seizures but also helped correct other features of malabsorption like hypocalcaemia and anaemia as the primary pathology behind these symptoms was corrected. We wish to highlight that hypocalcaemia of CD which may present as intractable seizures can be treated only by treating CD with gluten free diet and not by oral vitamin D and Calcium alone.
乳糜泻（CD）是一种麸质敏感性肠病，严重程度范围广泛，临床表现多样。非典型（非腹泻型）表现的患者常被漏诊，因为未考虑到乳糜泻的诊断。我们报告了三名年轻女孩（就诊时年龄分别为18岁、19岁、23岁），她们因难治性癫痫发作入院。所有患者均有低血钙、佝偻病/骨软化症特征及贫血。这促使我们考虑是由乳糜泻导致的吸收不良。通过血清学检测（IgA转谷氨酰胺酶和IgG抗麦醇溶蛋白抗体）及十二指肠活检确诊为乳糜泻。在所有患者中，无麸质饮食不仅使癫痫发作无需药物控制，还因纠正了这些症状背后的主要病理状况，帮助改善了其他吸收不良特征，如低钙血症和贫血。我们希望强调，乳糜泻导致的低钙血症若表现为难治性癫痫发作，仅通过无麸质饮食治疗乳糜泻才能治愈，而不能仅靠口服维生素D和钙。
