CASE REPORT: “Fulminant Celiac Disease Presenting in the Postpartum Period”
Hi everyone,
I came across to this “Fulminant Celiac Disease Presenting in the Postpartum Period” case report on coeliac disease and would like to discuss it. References are in the bottom of the page.
Celiac disease (CD) is an immune-mediated disorder triggered by gluten ingestion, affecting the small intestine. Its prevalence is rising globally, with common symptoms including diarrhea and extraintestinal manifestations such as anemia and osteoporosis. Although my symptoms are really different! If I get contaminated I get “brain-fog” (I can’t think properly!!) and constipation.
Undiagnosed celiac disease during pregnancy poses significant risks, as evidenced by a range of adverse outcomes. Pregnant women with untreated CD may experience intrauterine fetal growth restriction, stillbirth, spontaneous abortion, preterm delivery, cesarean delivery, and low mean birthweight. These complications underscore the importance of early detection and management of celiac disease in pregnant individuals, highlighting the need for heightened awareness and screening protocols to safeguard maternal and fetal health.
Pregnancy and Celiac Disease
Undiagnosed CD during pregnancy can lead to adverse outcomes, but it rarely presents during this time. Cases of fulminant CD, known as celiac crisis, in the postpartum period are scarce.
Case Report
A 34-year-old woman with chronic iron deficiency anemia and intermittent diarrhea presented postpartum with severe symptoms, including watery diarrhea, weight loss, and metabolic imbalances. She was diagnosed with celiac crisis based on clinical presentation and biopsy findings. However, since her 10 years old she had anemia! My guess is that she has always been celiac.
Discussion
While CD is typically diagnosed in childhood, it’s increasingly recognized in adults, with various manifestations. Pregnancy and the postpartum period can trigger CD presentation, although cases are rare. Hormonal changes during pregnancy may influence the course of autoimmune diseases like CD. More cases are emerging in which when a person undergoes significant life challenges, it can trigger celiac disease or exacerbate symptoms, as is likely occurring in this case study.
Management and Follow-Up
Diagnosing CD involves multiple duodenal biopsies or serologic testing. Treatment includes a gluten-free diet, with emphasis on achieving intestinal healing. Long-term follow-up is crucial to monitor for complications and ensure dietary adherence.
Conclusion
Fulminant CD in the postpartum period is a rare but serious condition that requires prompt diagnosis and management. Understanding its presentation and triggers can aid in early recognition and treatment. That’s why I like the approach in Ireland, if the person is anemic they always do blood test for CD!
Personal Connection
I recently encountered a similar case involving one of my professor’s dad (60yo). He developed fulminant CD after heart surgery. He was not recovering and always feeling weak. Despite initial confusion, a timely diagnosis and dietary changes led to significant improvement in his health, but was a shock to their family!
Understanding the complexities of celiac disease, especially its rare presentations like fulminant cases in the postpartum period, underscores the importance of awareness and vigilance in clinical practice!
Disclosure
Please note that this blog discusses scientific publications related to celiac disease, autoimmune diseases, and personal experiences. I am a pharmacist with a Ph.D in immunology and a post-doctorate in gastroenterology so I enjoy reading publications 😁. By the way, my mom and I are both celiacs.
It is important to remember that scientific research is an ongoing process and findings can change over time. While I strive to present accurate information based on the publications I review, my discussion of these publications should not be taken as a confirmation of their findings.
It is also important to keep in mind that there is still much that is unknown about celiac disease, autoimmune diseases, and their treatment. Therefore, any information presented on this blog should be considered in the context of the discussed publication and should not be used as a substitute for professional medical advice.
We encourage readers to discuss any questions or concerns they may have about diseases with their healthcare provider, who can provide individualized guidance based on the latest clinical practice guidelines.
References
Kuwelker, Saatchi MD1; Soni, Riya1; Perez-Sanchez, Ariadna MD1; Coss, Elizabeth MD1,2; Soni, Nilam J. MD, MS1,2. Fulminant Celiac Disease Presenting in the Postpartum Period. ACG Case Reports Journal 11(3):p e01234, March 2024. | DOI: 10.14309/crj.0000000000001234
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