An Interesting Cause Of Generalized Edema; A Case Report

Celiac disease is a small intestine malabsorption syndrome triggered in genetically susceptible individuals by ingestion of gluten-containing diet. Celiac is often characterized by gastrointestinal symptoms such as diarrhea, abdominal pain, vomiting, bloating, constipation and steatorrhea, yet it may be associated with extraintestinal symptoms such as edema, weight loss, osteoporosis and anemia. The variety of clinical presentations of celiac often resultsing in delay diagnosis which may lead to serious complications.A 47-year-old woman with generalized edema and exertional dyspnea was admitted. On physical examination, the conjunctiva was pale, the abdomen had significant ascites and she had bilateral symmetric 3+ pitting edema from ankle to thigh. Heart and lung examinations, CXR, ECG and echocardiography were normal. Renal function tests and sonography were normal. In laboratory tests, microcytic hypochromic anemia, prolonged PT, hypocalcemia, hypophosphatemia and AST ALT increased titer was observed. Reduction in Hemoglobin, serum albumin, vitamin D and ferritin was observed. Thus, was raised the possibility of cirrhosis for this patient. But ultrasound of liver and spleen was normal and thrombocytopenia not seen. The prolonged PT in this patient was recovered by administering vitamin K that also undermines the diagnosis of liver cirrhosis. Thus, was raised the possibility of malabsorption. So, performed celiac serological tests, Upper endoscopy and biopsy from D2 folds. Anti-TTG and EMA antibodies titer was increased. Atrophy in D2 folds and scalloping was seen in endoscopy. Pathologic findings were compatible with celiac disease, grade 3c according to Marsh criteria. Gluten-free diet started for patient. After 6 months follow-up, her clinical and paraclinical conditions were improved.Celiac disease is a malabsorption syndrome which impairs the absorption of protein, leads to hypoalbuminemia and a decrease in plasma colloid pressure resulting in generalized edema. So, It is recommended, be raised the possibility of celiac disease in the treatment of generalized edema with unknown causes.