McNicholas Bairbre Aine, Bell Marcia
Department of Nephrology, Merlin Park Hospital, Galway, Ireland.
BMJ Case Rep. 2010 Dec 1;2010:bcr0920092262. doi: 10.1136/bcr.09.2009.2262.
A 36-year-old gentleman presented with 6 months of poor energy, tingling in fingers and weight loss with a change in bowel habit. He appeared cachectic and had clubbing, demineralisation of teeth, pectus carinatus, kyphosis, spinal tenderness, proximal muscle weakness and generalised muscle atrophy. Chvostek's and Trosseau's signs were positive. His haemoglobin (Hb) was 8.7 g/dl, MCV 64.7 fl with low iron. Calcium corrected was 1.30 nmol/l, parathyroid hormone 440.4 ng/l, vitamin D <12.5 nmol/l; INR was 2.7 with coagulation inhibitor studies negative. Radiographs of spine and pelvis commented on osteopenia with thoracic kyphosis and mild anterior wedging of thoracic vertebrae. Antitissue transglutaminase was 145 U/ml, and antiendomysial antibodies were positive. An oesophagogastroduodenoscopy was consistent with coeliac disease. A diagnosis of osteomalacia and coagulopathy secondary to coeliac disease was made. The hypocalcaemia was treated with calcium gluconate infusions with symptomatic relief. Coagulopathy was treated with vitamin K intravenously with normalisation of INR. Following treatment with coeliac diet, calcium slowly normalised.
一名36岁男性患者，6个月来一直感到精力不足、手指刺痛、体重减轻且排便习惯改变。他看起来消瘦，有杵状指、牙齿脱矿、鸡胸、脊柱后凸、脊柱压痛、近端肌无力和全身肌肉萎缩。Chvostek征和Trousseau征呈阳性。他的血红蛋白（Hb）为8.7 g/dl，平均红细胞体积（MCV）为64.7 fl，铁含量低。校正后的钙为1.30 nmol/l，甲状旁腺激素为440.4 ng/l，维生素D<12.5 nmol/l；国际标准化比值（INR）为2.7，凝血抑制剂研究结果为阴性。脊柱和骨盆的X线片显示有骨质减少，伴有胸椎后凸和胸椎轻度前缘楔形改变。抗组织转谷氨酰胺酶为145 U/ml，抗肌内膜抗体呈阳性。食管胃十二指肠镜检查结果符合乳糜泻。诊断为乳糜泻继发骨软化症和凝血病。低钙血症通过静脉输注葡萄糖酸钙治疗，症状得到缓解。凝血病通过静脉注射维生素K治疗，INR恢复正常。采用乳糜泻饮食治疗后，血钙逐渐恢复正常。
