Elsevier

Journal of Hepatology

Volume 30, Issue 2, February 1999, Pages 321-324
Journal of Hepatology

Case Report
Autoimmune cholangitis in a patient with celiac disease: a case report and review of the literature

https://doi.org/10.1016/S0168-8278(99)80079-8Get rights and content

Abstract

Autoimmune cholangitis is a rare chronic cholestatic liver disease. We describe the case of a 65-year-old woman with celiac disease who presented to us with fever, jaundice and weight loss. Serum biochemical study showed marked increase in alkaline phosphatase and γGT levels. Antinuclear antibodies were positive, while antimitochondrial and anti-smooth-muscle antibodies were negative. Liver biopsy was compatible with primary autoimmune cholangitis. The patient was successfully treated with azathioprine and methylprednisolone. We describe here the uncommon association of autoimmune cholangitis with celiac disease and review the prevalence of liver diseases in patients with celiac disease.

Section snippets

Case Report

A 65-year-old housewife was admitted to our hospital in June 1995 with diarrhea, anemia and weight loss of 10 kg during the last 6 months. Our patient had had a history of autoimmune thyroiditis since 1993. Jejunal biopsy showed villous atrophy, blunting and flattening of the mucosal surface and infiltration of inflammatory cells in the lamina propria (Fig. 1), while serum antigliadin IgA and IgG antibodies (AGA) were positive. Serum calcium, albumin and iron levels were decreased and a

Discussion

Celiac sprue is a disease characterized by malabsorption, abnormal small bowel structure and function and intolerance to gluten, a protein found in wheat and its products. The intestinal lesion may be the result of a toxic effect of gluten or its products on the intestinal epithelium. It has also been proposed that gluten or its metabolites may initiate an immunological reaction in the intestinal mucosa. The interaction of T-cells with crypt epithelium may be a primary event in the pathogenesis

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