SHM Converge Scientific Abstract ePoster Gallery-Celiac Disease Associated With Idiopathic Thrombocytopenia-a Look Into Poly-Autoimmunity

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This case describes a 62-year-old man with a long history of recurrent nosebleeds, bleeding after dental procedures, and intermittent iron-deficiency anemia who was admitted after a traumatic head injury causing subarachnoid and subdural hemorrhage. On evaluation, he was found to have normocytic anemia and severe thrombocytopenia. Imaging showed no splenomegaly or liver disease, peripheral smear was unrevealing, and bone marrow biopsy did not identify another cause. After an extensive negative workup, his thrombocytopenia was diagnosed as immune thrombocytopenia (ITP), a diagnosis of exclusion.<br /><br />Although he had no classic gastrointestinal symptoms of malabsorption, routine testing revealed multiple vitamin and mineral deficiencies. This led to further evaluation for an occult malabsorptive disorder, and both celiac serology and duodenal biopsy confirmed celiac disease. He was started on a gluten-free diet along with iron, folate, and vitamin B12 replacement. Because platelet transfusions had little effect, he was treated with IVIG and steroids, and later eltrombopag, which improved his platelet count.<br /><br />The report highlights poly-autoimmunity, the coexistence of more than one autoimmune disease in the same patient. While celiac disease is known to associate with other autoimmune conditions, its link with ITP is less well established. The authors note that available studies suggest a higher-than-expected overlap between celiac disease and ITP in both directions. This case underscores the importance of considering hidden autoimmune disease when one autoimmune disorder is present, especially when a condition such as ITP is unusually severe or difficult to manage.

Asset Subtitle

Aditi Bawa

Meta Tag

Author List Aditi Bawa, David Levinthal

Category Clinical Vignettes

Concept Severe Thrombocytopenia

Concept Immune Thrombocytopenia

Concept Diagnosis of Exclusion

Concept Celiac Disease

Concept Poly-autoimmunity

Distinguished Non-Finalist

Presenter Organization UPMC McKeesport

Presenting Author Aditi Bawa

Track Adult

Keywords

immune thrombocytopenia

celiac disease

poly-autoimmunity

thrombocytopenia

subarachnoid hemorrhage

subdural hemorrhage

iron deficiency anemia

malabsorption

gluten-free diet

eltrombopag

Severe Thrombocytopenia

Immune Thrombocytopenia

Diagnosis of Exclusion

Celiac Disease

Poly-autoimmunity