PALERMO APRIL 2014

Virtut Velmishi

AMBRA18 MONTHS

BRIEF STORY First Child Normal pregnancy Birth weight= 3kg Exclusive breastfeeding for 6 months Complementary foods after this period Until 12 months everything ok

PROBLEMS

Chronic diarrhea Malnutrition Failure to thrive 2 hospitalisations Dermatitis ( treated several times by

dermatologist)

LABWBC=12000; RBC=5.080.000;HGB=7.7g/dl; PLT=358000Urinary analisis = normalalbuminemia=1,9AST=123 U/LALT=88 U/LIgA anti TTG> 100 UI /mlTotale IgA =normal

Weight=7,5 kg(-2,5DS)Height=79cm(-2DS)

HYPOPROTEINEMIC EDEMA

DERMATITIS HERPETIFORME

DERMATITIS HERPETIFORME

GLUTEN FREE DIET

FIQERETE16 MONTHS OLD

BRIEF STORY First child Birth weight =3400 g Normal pregnancy, normal delivery Exclusive breast fed first month After she is fed by formula milk 3 ½ month supplemental foods ( gluten

also) 2 hospitalizations: - 2 months : respiratory infection - 4 months : acute gastroenteritis No familiary disease

FOUR MONTHS AGO( 12 MONTH OLD)CHRONIC DIARRHEAFAILURE TO THRIVE VOMITING

LAB WBC=12000; RBC=5.080.000;HGB=9.7g/dl;

PLT=358000 Urinary analisis = normal

IgA anti DPG=107 u/mlTotal IgA=normal

Totale IgA=108 u/ml

DUODENAL BIOPSY

BIOPSY Marsh 3 C

Gluten free diet

GROWTH CHART

BUT ....TWO WEEKS AGO Polyuria Polydipsia Glycaemia=459 mg/dl Ketonuria= +++++ Kussmal respiration Ph=7.1; HCO3= 4.4 ; HbA1C = 7.4

SECOND DIAGNOSIS

Diabetic ketoacidosis

Coeliac disease association: T1DM

CONCLUSIONS

…some authors hypothized that in genetically susceptible patients one disease could predispose to another

… in patients with T1D, diabetes is usually diagnosed first, CD precedes diabetes onset only in 10-25%