Alfaris Abdullah, Alamri Ghadi Awad, Kurdi Amr Mohammed, Mallisho Ammar, Al Awaji Nisreen
Rehabilitation Department, King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia.
Department of Health Communication Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia.
Int Med Case Rep J. 2023 Jul 22;16:425-431. doi: 10.2147/IMCRJ.S415775. eCollection 2023.
A 16-year-old female presented to our hospital clinic with a main complaint of difficulty swallowing. She reported mild dizziness and frequent fatigue and denied weight loss, fever, joint pain, or a history of diarrhea. Lab and physical results showed low weight; low hemoglobin, ferritin, and vitamin D levels; and a low red blood cell count. Swallowing assessment showed esophageal webs and swallowing difficulty, especially in the pharyngeal stage, and aspiration. It was initially suspected that clinical manifestations, including esophageal webs, iron deficiency anemia (IDA), and swallowing difficulty, were related to Plummer-Vinson syndrome (PVS). However, further investigations and pathological findings revealed several gastrointestinal manifestations consistent with celiac disease (CD). Based on this finding, the patient began a gluten-free diet for the management of CD. Afterward, she began to gain weight, followed by a resolution of swallowing difficulty. Therefore, clinicians should be familiar with the symptoms of CD when conducting a thorough clinical examination and maintain a high level of suspicion to rule out other causes and reach an accurate diagnosis. It is also recommended to screen all patients presenting with IDA, esophageal web, and dysphagia for CD even in the absence of diarrhea.
一名16岁女性因吞咽困难为主诉前来我院门诊。她自述有轻度头晕和频繁疲劳,否认体重减轻、发热、关节疼痛或腹泻病史。实验室检查和体格检查结果显示体重低、血红蛋白、铁蛋白和维生素D水平低以及红细胞计数低。吞咽评估显示有食管蹼和吞咽困难,尤其是在咽期,并有误吸。最初怀疑包括食管蹼、缺铁性贫血(IDA)和吞咽困难在内的临床表现与普卢默-文森综合征(PVS)有关。然而,进一步检查和病理结果显示了一些与乳糜泻(CD)相符的胃肠道表现。基于这一发现,患者开始采用无麸质饮食来治疗CD。此后,她开始体重增加,随后吞咽困难得到缓解。因此,临床医生在进行全面临床检查时应熟悉CD的症状,并保持高度怀疑以排除其他病因并做出准确诊断。即使没有腹泻,也建议对所有出现IDA、食管蹼和吞咽困难的患者进行CD筛查。