Abstract / Summary
Celiac disease is an immune-mediated enteropathy triggered by dietary gluten.Celiac crisis is a severe manifestation characterized by profuse diarrhea, dehydration, hypotension, and severe metabolic derangements.We describe the case of an elderly patient with a remote childhood diagnosis of celiac disease who presented in celiac crisis.A 79-year-old man with hypertension managed on olmesartan presented with two weeks of severe watery diarrhea, weight loss, and edema that progressed to hypotension, acute kidney injury, and profound electrolyte abnormalities, necessitating multiple hospitalizations.Celiac serologies were markedly elevated, and he subsequently disclosed a childhood diagnosis of celiac disease that he had believed resolved.Duodenal biopsies demonstrated duodenitis with intraepithelial lymphocytosis and villous blunting.His symptoms persisted despite a gluten-free diet, withholding olmesartan, and supportive care but improved rapidly after initiation of budesonide.He was diagnosed with celiac crisis, with a possible contribution from olmesartan-associated enteropathy.Repeat endoscopy eight months later showed histologic remission.Celiac crisis should be considered in any patient presenting with severe diarrhea, dehydration, and metabolic abnormalities, especially when there is evidence of underlying celiac disease.In this patient, concurrent olmesartan use raised the possibility of a superimposed drug-induced enteropathy; although olmesartan was discontinued five days before budesonide was started, its contribution cannot be excluded and remains a confounding factor.Even so, this case highlights the importance of promptly recognizing celiac crisis and suggests a potential role for budesonide in patients whose symptoms persist despite gluten withdrawal and supportive care.