Kawano Nobuyuki, Itonaga Tomoyo, Tojigamori Manabu, Daa Tsutomu, Ihara Kenji
Department of Pediatrics, Oita University Faculty of Medicine, Oita, Japan.
Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan.
Clin Pediatr Endocrinol. 2021;30(2):105-110. doi: 10.1297/cpe.30.105. Epub 2021 Apr 3.
Vitamin D deficiency is a major cause of hypocalcemic seizures in infants. Chronic enteropathy can cause both malnutrition and vitamin deficiency disorders, such as celiac disease, in Western Caucasians. However, gluten-related disorders are considered uncommon in most Asian countries, and there have been no reports of any infant being diagnosed with a gluten-related disorder in Japan. Here, we describe a case where a Japanese infant, with non-celiac gluten sensitivity, presented with hypocalcemic seizures resulting from a vitamin D deficiency. In this case, an eight-month-old boy had an afebrile seizure, and blood tests revealed both hypocalcemia and prolonged prothrombin time resulting in his transfer to our hospital. The presence of fatty stools and evidence of multiple vitamin deficiencies indicated some form of fat malabsorption. His laboratory and histological findings showed enteropathy, and he was thus diagnosed with non-celiac gluten sensitivity. Therefore, he was treated with a gluten-free diet supplemented with vitamins. This case suggests that infants with a vitamin D deficiency caused by celiac disease or non-celiac gluten sensitivity should be carefully monitored when they are given oral supplements of vitamin D, to prevent any adverse side-effects associated with the varied roles of vitamin D in the immune response.
维生素D缺乏是婴儿低钙血症性惊厥的主要原因。在西方高加索人中,慢性肠病可导致营养不良和维生素缺乏症,如乳糜泻。然而,在大多数亚洲国家,麸质相关疾病被认为并不常见,在日本也没有任何婴儿被诊断出患有麸质相关疾病的报道。在此,我们描述了一例日本婴儿的病例,该婴儿患有非乳糜泻性麸质敏感,因维生素D缺乏而出现低钙血症性惊厥。在这个病例中,一名八个月大的男孩出现无热惊厥,血液检查显示低钙血症和凝血酶原时间延长,因此被转诊至我院。脂肪便的存在和多种维生素缺乏的证据表明存在某种形式的脂肪吸收不良。他的实验室检查和组织学检查结果显示有肠病,因此被诊断为非乳糜泻性麸质敏感。因此,他接受了无麸质饮食并补充维生素的治疗。该病例表明,对于因乳糜泻或非乳糜泻性麸质敏感导致维生素D缺乏的婴儿,在给予口服维生素D补充剂时应仔细监测,以预防与维生素D在免疫反应中的多种作用相关的任何不良副作用。