Description of a clinical case of seronegative celiac disease in a 5-year-old girl

Abstract

Introduction. Celiac disease is an immuno-mediated systemic disease, which is defined as intolerance to gluten and the corresponding prolamins in the mucous membrane of the small intestine in genetically predisposed children, and is characterized by the development of atrophic enteropathy. The seronegative form of celiac disease, in which serological markers are not determined, but the development of appropriate symptoms and the effect of gluten-free diet (GFD) is observed, still remains a diagnostic and therapeutic dilemma.Objectives. Analysis of a clinical case of a child with seronegative celiac disease (SNCD).Results. The disease in a young child before the final diagnosis was severe due to chronic diarrhea and severe flatulence. The girl received outpatient treatment at the place of residence several times with a short-term positive effect, the condition worsened in dynamics: the child lost weight, stopped walking. At the age of 5, she was hospitalized in the gastroenterology department of the Republican Specialized Scientific and Practical Medical Center of Pediatrics, where, on the bases of normal values of antibodies to tissue transglutaminase and total IgA and IgG (анти-tTG IgA and G), changes in biopsies of the mucosa of the postbulary department of the duodenal bulb, characteristic of Marsh 3, and the presence of HLA DQ2, seronegative celiac disease was supposed to diagnose. The girl was prescribed GFD, symptomatic drug therapy was performed. The dynamics of the condition has improved. After 6 months, at the second visit, there were no gastrointestinal symptoms, physical development corresponded to age, what could help to confirm diagnosis of seronegative celiac disease.Conclusions. This clinical case in a girl with a classic form of celiac disease and severe atrophy of the mucosa of the bulbous small intestine, HLA DQ2, was accompanied by normal values of анти-tTG and total IgA. Treatment of a gluten-free diet was very effective: the girl fully compensated for weight deficiency and laboratory tests.