Sarcoidosis, Celiac Disease and Deep Venous Thrombosis: a Rare Association

Sarcoidosis is a multisystem granulomatous disorder of unknown etiology and it may rarely be associated with a second disorder. Celiac disease is an immune-mediated enteropathy characterized with malabsorption caused by gluten intolerance, and several reports indicate an association between celiac disease and sarcoidosis. In addition, although celiac disease is associated with several extraintestinal pathologies, venous thrombosis has been rarely reported. Herein we present a rare case report of a patient with a diagnosis of sarcoidosis, celiac disease and deep venous thrombosis because of the rare association of these disorders. The patient was admitted with abdominal pain, weight loss, chronic diarrhea and a 5-day history of swelling in her right leg. A diagnosis of deep venous thrombosis was achieved by doppler ultrasonographic examination. The diagnosis of celiac disease was made by biopsy of duodenal mucosa and supported with elevated serum level of anti-gliadin IgA and IgG, and a diagnosis of sarcoidosis was achieved by transbronchial needle aspiration from the subcarinal lymph node during flexible bronchoscopy.

Keywords:

Sarcoidosis, celiac, venous thrombosis,

PDF

___

Statement on Sarcoidosis. Joint statement of the American Thoracic Society (ATS), European Respiratory Society (ERS) and the World Association of Sarcoidosis and Other Granulomatous Diseases (WASOG) adopted by the ATS Board of Directors and by the ERS Executive Committee, February 1999. Am J Respir Crit Care Med 1999;160:736-55.
Rutherford RM, Brutsche MH, Kearns M, Bourke M, Stevens F, Gilmartin JJ. Prevalence of coeliac disease in patients with sarcoidosis. Eur J Gastroenterol Hepatol 2004;16:911-5. [CrossRef]
Papadopoulos K, Sjoberg K, Lindgren S, Hallengren B. Evidence of gastrointestinal immune reactivity in patients with sarcoidosis. J Intern Med 1999;245:525-31. [CrossRef]
Hwang E, McBride R, Neugut A, Gren HP. Sarcoidosis in Patients with Coeliac Disease. Dig Dis Sci 2008;53:977-81. [CrossRef]
Bianconcini G, Mazzali F, Candini R, Silingardi M, Lori I. Celiac disease (familial) associated with sarcoidosis. Clinical case and review of the literature. Minerva Med 1994;85:541-53.
Douglas JG, Gillon J, Logan RF, Grant IW, Crompton GK. Sarcoidosis and coeliac disease: an association? Lancet 1984;7;2:13-5. [CrossRef]
Gardner J, Kennedy HG, Hamblin A, Jones E. HLA associations in sarcoidosis: a study of 2 ethnic groups. Thorax 1984;39:19-22. [CrossRef]
Martinetti M, Tinelli C, Kolek V, Cuccia M, Salvaneschi L, Pasturenzi L, et al. ‘The sarcoidosis map’: a joint survey of clinical and immunogenetic findings in two European countries. Am J Respir Crit Care Med 1995;152:557-64.
Sollid LM, Thorsby E. HLA susceptibility genes in celiac disease: genetic mapping and role in pathogenesis. Gastroenterology 1993;105:910-22.
Ludvigsson JF, Welander A, Lassila R, Ekborn A, Monygomer SM. Risk of thromboembolism in 14,000 individuals with coeliac disease. Br J Haematol 2007;139:121-7.[CrossRef]
Kremer Hovinga JA, Baerlocher G, Wuillemin WA, Solenthaler M. Deep venous thrombosis of the leg in acquired thrombophiliahyperhomocysteinemia as a sequela of undetected coeliac disease. Ther Umsch 1999;56:519-22. [CrossRef]
Saibeni S, Lecchi A, Meucci G, Cattaneo M, Tagliabue L, Rondonotti E, et al. Prevalance of hyperhomocysteinemia in adult gluten-sensitive enteropathy at diagnosis: role of B12, folate and genetics. Clin Gastroenterol Hepatol 2005;3:574-80. [CrossRef]
Bahloul M, Chaari A, Khlaf-Bouaziz N, Kallel H, Chaari L, Ben Hamida C, et al. Coeliac disease cerebral venous thrombosis and protein S deficiency, a fortuitous associaton? J Mal Vasc 2005;30:228-30. [CrossRef]
Kallel L, Matri S, Karoui S, Fekih M, Boubaker J and Filali A. Deep Venous Thrombosis Related to Protein S Deficiency Revealing Celiac Disease. Am J Gastroenterol 2009;104:256-7. [CrossRef]
Ouakaa-Kchaou A, Ennaifer R, Belhadi N, Garoouri D, Elloumi H, Romani M, et al. Celiac disease associated with Budd-Chiari syndrome. Presse Med 2008;37:239-41.