CASE REPORT
Celiac disease presenting as fever of unknown origin in the adult: The role of undiagnosed celiac disease in systemic atherosclerosis
 
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Department of Internal Medicine, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Italy
CORRESPONDING AUTHOR
Gabriele Cioni   

Department of Internal Medicine, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Viale Morgagni, 85 50134, Florence, Italy. Tel.: +39331 1357167.
Submission date: 2017-04-28
Acceptance date: 2017-09-04
Online publication date: 2018-04-20
Publication date: 2019-11-18
 
Pol. Ann. Med. 2018;25(2):241–244
 
KEYWORDS
ABSTRACT
Introduction:
Celiac disease is an inflammatory disorder affecting subjects at any age and presenting with a broad spectrum of symptoms. In several cases, extra-intestinal symptoms are the only clinical manifestations or occur in conjunction with gastrointestinal symptoms.

Aim:
We present the case of a 47-year-old male admitted to our Internal Medicine Department, after a further episode of fever with chill, associated with headache and malaise.

Case study:
He had suffered from episodes of fever for about 20 years. At physical examination, gastrointestinal symptoms such as nausea, emesis, diarrheal and constipation, were absent.

Results:
Investigations were negative for malignancy, haematological disorders, autoimmune diseases, and inflammatory bowel disease; serological and culture tests were negative for common infectious diseases and parasitosis. Inflammatory markers were elevated (erythrocyte sedimentation rate 48 mm/h, C-reactive protein 185 mg/L), with the exception of normal procalcitonin levels. Colonoscopy demonstrated villous blunting, with biopsies consistent with a diffuse chronic inflammation in the lamina propria and significant intraepithelial lymphocytosis (MARSH II). Further investigations showed an advanced atherosclerotic peripheral disease, despite the low cardiovascular risk.

Discussion:
In celiac disease, the activation of gluten specific T cells in the gastrointestinal mucosa induces the activation of a pro-inflammatory pattern, which could contribute to the fever. The systemic inflammatory activation found in celiac disease was associated to a chronic vascular damage, both consisting in an increased arterial stiffness and intima-media-thickness.

Conclusions:
The delay in diagnosis of celiac disease could be associated to several complications, such as atherosclerotic progression.

CONFLICT OF INTEREST
None declared.
 
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