BMJ Case Reports 2012; doi:10.1136/bcr-03-2012-6112
  • Reminder of important clinical lesson

Elevated liver enzymes, anaemia and osteopaenia in a young woman

  1. Lise Lotte Gluud3
  1. 1Research Center of Aging and Osteoporosis, Department of Medicine, Glostrup University Hospital, Denmark
  2. 2Faculty of Health Sciences, University of Copenhagen, Denmark
  3. 3Medical Department F, Gentofte Hospital, Gentofte, Denmark
  1. Correspondence to Barbara Rubek Nielsen, Barbara_rubek{at}

A 23-year-old woman presented with elevated liver enzymes, anaemia and lower limb oedema. Iron-deficiency anaemia due to gynaecological problems was suspected. The patient was treated with iron supplements normalising the blood haemoglobin. Alcohol binge drinking was suspected to be the cause of elevated liver enzymes. After 7 years, the patient presented to our outpatient clinic with non-specific gastrointestinal symptoms. Blood tests revealed low levels of serum s-iron and elevated liver function tests. Abdominal ultrasound was normal. No signs of viral hepatitis or hereditary liver disease were detected. There was a marked elevation of tissue transglutaminase antibodies. A small intestine biopsy confirmed the diagnosis of coeliac disease. A bone density scan showed osteopaenia. Following a gluten-free, lactose-reduced diet, the gastrointestinal symptoms disappeared and s-transaminase activity and s-iron levels normalised.


  • Competing interests None.

  • Patient consent Obtained.

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