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Hemorrhagic Events in Adult Celiac Disease Patients. Case Report and Review of the Literature

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Alina Dima1, Ciprian Jurcut2, Anca Manolache2, Daniel Vasile Balaban1,2, Alina Popp1,3,4, Mariana Jinga1,2

1) Carol Davila University of Medicine and Pharmacy;
2) Dr. Carol Davila Central Military Emergency University Hospital;
3) Alessandrescu-Rusescu Institute for Mother and Child Health, Bucharest, Romania
4) Tampere Centre for Child Health Research, University of Tampere, Tampere University Hospital, Tampere, Finland

DOI: http://dx.doi.org/10.15403/jgld.2014.1121.271.cld


Background & Aims: Celiac disease (CD) presents with a wide spectrum of extra-digestive symptoms, including hemorrhagic manifestations. The aim of this review was to conduct an extensive analysis of the hemorrhagic events reported in adult CD patients.
Methods: Case report and review of the literature. Pubmed (MEDLINE) database search from January 1970 onwards was performed using the medical subject headings [MeSH] terms “celiac disease” AND “blood coagulation disorders”, “hemorrhage”, “hematoma”, “hematuria”, “hemoptysis”, “epistaxis”, “hemosiderosis”.
Only case reports were identified on the search theme. Information on patients’ characteristics, diagnostic features, coagulation parameters, symptomatology duration, and evolution under treatment were systematically collected and summarized.
Results: We present the case of a 40-year-old man hospitalized for spontaneous muscular hematomas, in whom CD was diagnosed. We performed a review of the literature and summarized the published case reports of 46 CD patients, aged between 19 and 74 years, 64% of male gender. In 25% of cases, the symptomatology was present for more than 5 years prior to CD diagnosis. The clinical hemorrhagic events were as follows: 15 patients had gastrointestinal bleeding, 9 hemoptysis, 4 epistaxis, 6 hematuria, 8 cutaneous hematoma, petechia or ecchymoses, and only in 1 case hemarthrosis, hemorrhagic vesicular dermatitis, subcortical hemorrhage, or adrenal hemorrhage. Sixty percent of the patients had digestive symptoms, while the rest had only extradigestive CD involvement. The Lane Hamilton syndrome was defined in 15 patients. The evolution under a gluten-free diet was favorable in most cases.
Conclusion: This review of case reports aims to increase awareness to hemorrhagic events, rare but possible life-threatening conditions, as part of the CD clinical spectrum. To the best of our knowledge, this is the first review of all types of hemorrhagic events in adult CD patients.
Key words: celiac disease – Lane Hamilton syndrome – blood coagulation disorders – vitamin K.
Abbreviations: AGA: anti-gliadin antibodies; CD: celiac disease; DAH: diffuse alveolar hemorrhage; DIC: disseminated intravascular coagulation; DGP: anti-deamidated gliadin antibodies; EATL: enteropathyassociated T cell lymphoma; EMA: anti-endomysial antibodies; GFD: gluten-free diet; INR: international normalized ratio; IPH: idiopathic pulmonary hemosiderosis; LHS: Lane Hamilton syndrome; PLT: platelets; tTG: anti-tissue transglutaminase antibodies.