Concurrent cerebral arterial and venous sinus thrombosis revealing celiac disease- a case report and literature review
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(2020) 20:327
CASE REPORT
Open Access
Concurrent cerebral arterial and venous sinus thrombosis revealing celiac disease- a case report and literature review Dalia Alhosain1*
and Lamia Kouba2
Abstract Background: Celiac disease is an autoimmune condition characterized by an inappropriate immune reaction against gluten. It classically presents as chronic diarrhea, bloating, and nausea in addition to malabsorption symptoms such as weight loss and micronutrient deficiency. We report the first case of coinciding cerebral infarction and venous sinus thrombosis unveiling the diagnosis of celiac disease. Case presentation: A 40-year old female patient with a four-day history of severe diarrhea presented with right hemiplegia and altered mental status. Imaging revealed left middle cerebral artery occlusion and left transverse and sigmoid venous sinus thrombosis, along with left jugular vein thrombosis. Her laboratory evaluation was notable for profound iron deficiency anemia, thrombocytosis, and hyperhomocysteinemia. Her positive anti-tissue transglutaminase IgA antibodies and ensuing duodenal biopsy confirmed the diagnosis of celiac disease. Conclusions: Celiac disease has a wide range of intestinal and extraintestinal manifestations and can present with thrombotic events in young patients with iron deficiency and hyperhomocysteinemia. Keywords: Celiac disease, Stroke, Venous sinus thrombosis, Arterial thrombosis, Case report
Background Celiac disease (CD) is an autoimmune disease triggered by the exposure to gliadin; a protein component of gluten, in genetically susceptible individuals. The dysregulated immune response damages the intestinal mucosa in the duodenum and jejunum, leading to malabsorption and a constellation of extraintestinal manifestations. The clinical presentation of CD typically comprises gastrointestinal symptoms such as recurrent diarrhea, weight loss, abdominal bloating, and nausea or vomiting [1]. However, CD is commonly asymptomatic and may initially present with extraintestinal manifestations or with systemic complications of malabsorption syndrome, rendering this disease a diagnostic challenge. * Correspondence: [email protected] 1 Division of Gastroenterology and Hepatology, Damascus University Hospitals, Damascus University, Damascus, Syria Full list of author information is available at the end of the article
Celiac disease rarely manifests with thrombotic complications and when it does, the hepatic vessels are the most commonly involved [2]. In this report, we describe the first case of simultaneous arterial and venous thrombosis presenting as the initial manifestations of celiac disease. A summary of three proposed mechanisms of thrombosis in celiac disease is also described with the supporting evidence from the literature.
Case presentation A 40-year-old woman presented to our emergency department with deteriorating mental status. One day before, she suffered from a severe headache unresponsive to analgesics followed by right hemiparesis 4 h later. The patient’s family repo
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