gms | German Medical Science

We report about a 1 10/12 year old female toddler, who presented with failure to thrive and increased sweating (pyelonephritis at age of 10 mo). Wheat was introduced since age of 8 mo and weight did not increase since that. Blood was taken to ascertain the suspect of celiac disease.

According to the current guidelines (2010) the transglutaminase IgA antibodies were determined. The level was under the reference interval (< 20 U). In addition the level of gliadin IgG and IgA antibodies as well as F-actin (smooth muscle) IgA antibodies were determined. At that time gliadin IgG antibody titer was at 81.4 U (reference value < 20). This was the first and only laboratory hint of an existing celiac disease. The other celiac disease specific laboratory parameters were negative. Eight month later all celiac disease specific laboratory parameters became positive e.g. transglutaminase Ig A >125.0 U (reference value < 20). Positive F- actin antibodies (>125 U; reference value < 20) indicated villous atrophy. Diagnosis was further ascertained genetically by showing linkage to haplotype HLA DRB1*03 (DR3) and DQB1*02 (DQ2). Upon parental wish we restrained from doing a villous biopsy and started gliadin free nutrition at age of 1 6/12 y, leading to rapid weight gain and stop of clinical complaints. From this case we learned that in addition to the current guidelines the gliadin IgG antibodies can indicate a beginning celiac disease. Therefore it is advisable to add this parameter to the laboratory diagnostic panel because the switch to transglutaminase antibodies takes place a few months later.