JEJUNAL THICKENING IN SERONEGATIVE CELIAC DISEASE: CASE REPORT (Atena Editora)

Abstract

Introduction: Celiac disease (CD) is an immune-mediated systemic disease induced by gluten ingestion in patients with a genetic predisposition, leading to nutrient-losing enteropathy. Given the high sensitivity of serological tests, only 1% of celiac patients are seronegative. Case Report: 14-year-old patient hospitalized in a critical condition of malnutrition for about 4 months with weight loss of 15 kilograms, associated with liquid diarrhea with mucus, nausea, vomiting, epigastralgia and feeling of gastric fullness. Evolved with dehydration, intense asthenia and anasarca. Clinical and laboratory investigation was carried out: severe hypoalbuminemia, anemia and stool coprology with mucus, undigested muscle fibers, neutral fats and excess fatty acids. Upper digestive endoscopy with duodenal biopsy showing histological grading of Marsh III villous atrophy and CT enterography with circumferential wall thickening of the proximal jejunal segment, hyper uptake of contrast in the wall and luminal reduction of the proximal jejunum. Serological tests for celiac disease (anti-transglutaminase and anti-endomysium) were negative. Due to the clinical picture associated with imaging and histopathological findings, a hypothesis of seronegative celiac disease was raised. A gluten-free diet was started with complete symptomatic improvement after therapy and reversal of malnutrition. She maintained clinical follow-up with the team for a period of 12 months, remaining asymptomatic with gluten restriction. Discussion: Seronegative celiac disease is uncommon (1%) and its diagnosis is challenging due to the high sensitivity of serological tests (greater than 95%), which are even used as a screening for the condition, indicating the performance of duodenal biopsy. It is not associated with a worse prognosis. The clinical association with radiological and histopathological findings favors the diagnosis even with negative serological tests.