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Severe osteomalacia due to undiagnosed cœliac disease: three case reports of Tunisian women

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Abstract

We describe three cases of osteomalacia presenting in Tunisian women, all of whom had previously-undiagnosed cœliac disease (CD). Direct enquiry revealed an important weight loss and a history of diarrhoea in two patients, and a 15-year history of anaemia in one patient. Laboratory tests showed severe anaemia in the three cases. Reduced calcium was found in two cases, and corrected calcium was found in one case. Radiological examination showed fissure in two cases. The diagnosis of osteomalacia was made by clinical, biochemical and radiological features. Antigliadin, antireticulin, antiendomysial and anti-tissue transglutaminase antibodies were all positive in the three cases, and a small-bowel biopsy confirmed the diagnosis of CD. Treatment with gluten-free diet (GFD), supplemental calcium and vitamin D was initiated for the three patients, but only one patient complies strictly with the GFD; she showed a marked resolution of her symptoms.

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Abbreviations

AEA:

Antiendomysial antibodies

AGA:

Antigliadin antibodies

ARA:

Antireticulin antibodies

AtTGA:

Anti-tissue transglutaminase antibodies

BMD:

Bone mineral density

CD:

Cœliac disease

GFD:

Gluten-free diet

IEL:

Increased intraepithelial lymphocytes

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Authors and Affiliations

  1. Laboratory of Immunology, Farhat Hached Hospital, Rue Ibn El Jazzar, 4000, Sousse, Tunisia

    Hanène Landolsi, Amani Mankaï & Ibtissem Ghedira

  2. Rheumatology Unit, Farhat Hached Hospital, Sousse, Tunisia

    Elyès Bouajina & Hela Zeglaoui

  3. Gastroenterology Unit, Farhat Hached Hospital, Sousse, Tunisia

    Karim Skandrani

  4. Faculty of Pharmacy, Monastir, Tunisia

    Ibtissem Ghedira

Authors
  1. Hanène Landolsi
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  2. Elyès Bouajina
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  3. Amani Mankaï
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  4. Hela Zeglaoui
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  5. Karim Skandrani
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  6. Ibtissem Ghedira
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Corresponding author

Correspondence to Ibtissem Ghedira.

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Landolsi, H., Bouajina, E., Mankaï, A. et al. Severe osteomalacia due to undiagnosed cœliac disease: three case reports of Tunisian women. Rheumatol Int 26, 261–263 (2006). https://doi.org/10.1007/s00296-005-0618-6

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  • DOI: https://doi.org/10.1007/s00296-005-0618-6

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