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BMJ Case Reports 2010; doi:10.1136/bcr.09.2009.2262
  • Unusual presentation of more common disease/injury

Coeliac disease causing symptomatic hypocalcaemia, osteomalacia and coagulapathy

  1. Marcia Bell2
  1. 1Department of Nephrology, Merlin Park Hospital, Galway, Ireland
  2. 2Department of Endocrinology, Galway University Hospitals, Galway, Ireland
  1. Correspondence to Bairbre Aine McNicholas, bairbrenimhaille{at}gmail.com

Summary

A 36-year-old gentleman presented with 6 months of poor energy, tingling in fingers and weight loss with a change in bowel habit. He appeared cachectic and had clubbing, demineralisation of teeth, pectus carinatus, kyphosis, spinal tenderness, proximal muscle weakness and generalised muscle atrophy. Chvostek's and Trosseau's signs were positive. His haemoglobin (Hb) was 8.7 g/dl, MCV 64.7 fl with low iron. Calcium corrected was 1.30 nmol/l, parathyroid hormone 440.4 ng/l, vitamin D <12.5 nmol/l; INR was 2.7 with coagulation inhibitor studies negative. Radiographs of spine and pelvis commented on osteopenia with thoracic kyphosis and mild anterior wedging of thoracic vertebrae. Antitissue transglutaminase was 145 U/ml, and antiendomysial antibodies were positive. An oesophagogastroduodenoscopy was consistent with coeliac disease. A diagnosis of osteomalacia and coagulopathy secondary to coeliac disease was made. The hypocalcaemia was treated with calcium gluconate infusions with symptomatic relief. Coagulopathy was treated with vitamin K intravenously with normalisation of INR. Following treatment with coeliac diet, calcium slowly normalised.

Footnotes

  • Competing interests None.

  • Patient consent Obtained.

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