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

• Published in: Rheumatology international Vol. 26; no. 3; pp. 261 - 263
• Main Authors: LANDOLSI, Hanène, BOUAJINA, Elyès, MANKAÏ, Amani, ZEGLAOUI, Hela, SKANDRANI, Karim, GHEDIRA, Ibtissem
• Format: Journal Article
• Language: English
• Published: Berlin Springer 2006; Springer Nature B.V
• Subjects: Adult; Autoantibodies - blood; Biological and medical sciences; Calcium - blood; Celiac disease; Celiac Disease - complications; Celiac Disease - diagnosis; Diet; Disease; Diseases of the osteoarticular system; Female; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Medical sciences; Middle Aged; Osteomalacia - blood; Osteomalacia - etiology; Osteoporosis. Osteomalacia. Paget disease; Other diseases. Semiology; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Vitamin D; Vitamin D - blood; Human; Diseases of the osteoarticular system; Nutrition disorder; Rheumatology; Vitamin deficiency; Coeliac disease; Case study; Vitamin D; Intestinal malabsorption; Digestive diseases; Intestinal disease; Woman; Osteomalacia; Nutritional status
• ISSN: 0172-8172; 1437-160X
• DOI: 10.1007/s00296-005-0618-6

We describe three cases of osteomalacia presenting in Tunisian women, all of whom had previously-undiagnosed coeliac 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.