CELIAC-DISEASE (CELIAC SPRUE) - FIRST DIA GNOSED AFTER A BLEEDING COMPLICATION

History and clinical findings: A 47-year-old man without previously kn own illness was admitted to hospital because of acute haematomas in th e legs: the history revealed no cause. The pale-looking patient report ed having large and foul-smelling stools once or twice daily. There we re large haematomas and swellings on both legs. His general and nutrit ional state was reduced. ''Bleeding of unknown origin'' was suspected at this time. Investigations: Haemoglobin concentration was 5.6 g/dl, while iron was normal and ferritin reduced. Quick value was below 5%, activated partial thromboplastin time prolonged to 180s. Vitamin A and E concentrations were reduced; coumarin derivatives were not demonstr ated in blood. Abdominal ultrasonography showed clearly thickened inte stinal walls. Treatment and course: Four units of erythrocyte concentr ate were immediately administered, together with 2000 IU factors II, V II, X and antihaemophilic factor B (PPSB), and 10 mg vitamin K intrave nously. As intestinal malabsorption was suspected a vitamin A absorpti on test was performed: it indicated malabsorption. Upper intestinal en doscopy showed coeliac disease, as did a biopsy. The patient's state q uickly improved after he had been given vitamins A, D, E and K and put on a gluten-free diet. Conclusion: Coeliac disease can take a clinica lly unremarkable course for a long time and may finally become manifes t through an isolated abnormality, such as bleeding.