Case Report

A Reason For High Liver Function Test Results: Celiac Disease

  • Adil COŞKUN
  • İbrahim METEOĞLU
  • Vahit YÜKSELEN
  • Gürhan KADIKÖYLÜ
  • Zahit BOLAMAN

Received Date: 21.07.2009 Accepted Date: 03.11.2009 Meandros Med Dent J 2010;11(2):35-37

Celiac disease (CD) is the only autoimmune disorder caused by an environmental factor (gliadin). Recently it has been reported that transaminase increase was seen in 40% of the cases.A17 years old female patient was admitted for increased weakness in the last 6 months, which she has been complaining for 5 years. She didn't have diarrhea or dyspepsia. Except paleness, her examination was normal. Biochemical test results were as follows;ALP:1026 IU/L (originating from bone), AST:50 IU/L, ALT:71 IU/L, GGT:52 IU/L, total bilirubin: 1.93mg/L, direct bilirubin:1.34 mg/dL, Anti-HBs, HbsAg,Anti HCV,HAVIgM were negative, hemoglobin: 7.7g/dL, and ferritin: 2.92 ng/ml. Cholangiopancreaticography with magnetic resonance imaging was resulted normal. In DEXA, vertebral measurement T score was -5 and Z score was -4.7. Endomysial autoantibody (EMA) IgA, anti gliadin antibody IgA>200 RU/ml (>50 positive), and anti gliadin antibody IgG 61.5 RU/ml were positive. Liver biopsy showed focal spotty necrosis and cholestasis in parenchyma. Endoscopic duodenal biopsy showed villous atrophy, intense intraepithelial lymphocytes in surface epithelium. Intraepithelial lymphocytes were dyed diffusely with CD3 and CD8 in immunohistochemical staining but few were dyed positively with CD4 and CD20. Findings were in agreement with type 3B according to modified Marsh classification for CD. She was diagnosed with CD according to biopsy and antibody evaluation.Agluten free diet was started. In the first month of treatment except ALP increase (she was in puberty), AST, ALT, GGT, bilirubin values were normal. In conclusion, even if no diarrhea,CDmust be thought in differential diagnosis of increased liver function tests.

Keywords: Celiac disease, liver function tests, gluten free diet