Erriu Matteo, Canargiu Fernando, Orrù Germano, Garau Valentino, Montaldo Caterina
Dipartimento di Chirurgia e Scienze Odontostomatologiche, Università degli studi di Cagliari, Via Binaghi 4, Cagliari, CA, 09121, Italy.
J Med Case Rep. 2012 Jul 4;6:185. doi: 10.1186/1752-1947-6-185.
The aim of this case report is to show how an oral condition, such as atrophic glossitis, can be the only clinical sign that allows an early diagnosis of celiac disease.
Atrophic glossitis was detected by a dentist during a first routine examination of the oral cavity of a 17-year-old Sardinian young woman and then differential diagnosis was carried out to identify the etiology of her tongue condition. Considering the high prevalence of celiac disease in the patient's birth area, the clinician took a blood sample to search for vitamin deficiency and immunological anomalies typically linked to celiac disease. Positive blood sample results allowed the patient to be referred to a gastroenterologist in order to perform a small intestine biopsy. The biopsy showed a strong atrophy of the intestinal villus so that it was possible to make a sure diagnosis of celiac disease. After five months on a gluten-free diet, the oral clinician was not able to find any signs of atrophic glossitis.
Two important conclusions can be reached from this case report; first, the fundamental role played by the oral condition alone in finding and highlighting atypical forms of celiac disease and second, the importance of investigating systemic anomalies, in cases where there is a tongue condition such as atrophic glossitis and when it is impossible to identify local causes.
本病例报告的目的是展示一种口腔状况，如萎缩性舌炎，如何能够成为早期诊断乳糜泻的唯一临床体征。
一名17岁撒丁岛年轻女性在首次口腔常规检查时，牙医发现了萎缩性舌炎，随后进行了鉴别诊断以确定其舌部状况的病因。考虑到患者出生地乳糜泻的高患病率，临床医生采集了血液样本以查找通常与乳糜泻相关的维生素缺乏和免疫异常情况。血液样本检测结果呈阳性，使得患者被转诊至胃肠病专家处进行小肠活检。活检显示肠绒毛严重萎缩，从而得以确诊乳糜泻。在采用无麸质饮食五个月后，口腔临床医生未发现任何萎缩性舌炎的迹象。
从本病例报告可得出两个重要结论；其一，仅口腔状况在发现和凸显乳糜泻非典型形式方面所起的关键作用；其二，在出现如萎缩性舌炎等舌部状况且无法确定局部病因时，调查全身性异常情况的重要性。
