Murphy Andrew K, Norton Joseph A, Pflederer Benjamin R
Department of Medicine, University of Illinois College of Medicine, Peoria, IL, USA.
Department of Medicine, OSF St. Francis Medical Center, Peoria, IL, USA.
Am J Case Rep. 2020 Dec 24;21:e928337. doi: 10.12659/AJCR.928337.
BACKGROUND Celiac disease is very common, with some estimates placing the prevalence at approximately 1: 300 worldwide. Typified by autoimmune degradation of the duodenal brush border due to reactivity with dietary gluten, causing malabsorption, it classically presents with both gastrointestinal and extra-intestinal symptoms. Gastrointestinal symptoms commonly include diarrhea, constipation, foul steatorrhea, flatulence, and bloating. With increased awareness and availability of testing, it is rare that a patient would present with celiac crisis, which is a syndrome of profuse diarrhea and severe metabolic/nutritional disturbances. In children, interestingly, celiac disease can present primarily as behavioral disturbance, such as increased aggression or anxiety, with milder or absent gastrointestinal symptoms. CASE REPORT A 25-year-old man with a history of schizophrenia and autism spectrum disorder presented for behavioral disturbance after breaking into a neighbor's house to eat food. He also reported several months of diarrhea and fecal incontinence and was noted to have severe malnutrition on exam, despite dramatic food intake. Tissue transglutaminase IgA antibody (TTG) and gliadin IgA were highly suggestive of celiac disease, which was confirmed by biopsy. He was started on a lactose-free and gluten-free diet, and required a short course of total parenteral nutrition (TPN) for nutritional resuscitation. He improved rapidly with this intervention, and returned to nutritional and behavioral baseline. CONCLUSIONS We report a unique case in which an adult with psychiatric comorbidities presented with predominantly behavioral disturbances, a more common presentation in children with the disorder. These patients may present in an atypical fashion, and the clinician should have a high index of suspicion.
乳糜泻非常常见，据一些估计，全球患病率约为1:300。其典型特征是由于对饮食中的麸质产生反应，导致十二指肠刷状缘发生自身免疫性降解，引起吸收不良，通常会出现胃肠道和肠外症状。胃肠道症状常见包括腹泻、便秘、恶臭脂肪泻、肠胃胀气和腹胀。随着认识的提高和检测手段的普及，患者出现乳糜泻危象的情况已较为罕见，乳糜泻危象是一种伴有大量腹泻和严重代谢/营养紊乱的综合征。有趣的是，在儿童中，乳糜泻主要表现为行为障碍，如攻击性增强或焦虑，胃肠道症状较轻或无。病例报告：一名25岁男性，有精神分裂症和自闭症谱系障碍病史，在闯入邻居家吃东西后出现行为障碍。他还报告有几个月的腹泻和大便失禁，尽管食量很大，但检查发现他严重营养不良。组织转谷氨酰胺酶IgA抗体（TTG）和麦醇溶蛋白IgA高度提示乳糜泻，活检证实了这一诊断。他开始接受无乳糖和无麸质饮食，并因营养复苏需要短期的全胃肠外营养（TPN）。通过这种干预，他恢复得很快，并恢复到营养和行为基线水平。结论：我们报告了一例独特的病例，一名患有精神疾病合并症的成年人主要表现为行为障碍，而这在患有该疾病的儿童中更为常见。这些患者可能以非典型方式就诊，临床医生应保持高度怀疑。
