Ori Lencovsky, Daphna Katz-Talmor, Benjamin Aronoff
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引用次数: 0
Abstract
Celiac disease, a prevalent autoimmune disorder, can present atypically with fat malabsorption and coagulopathy due to vitamin K malabsorption. A 64-year-old male presented with haemoptysis and severe anaemia (Hb 6 g/dl). Despite normal previous coagulation tests, admission laboratory tests revealed an international normalised ratio (INR) of 7.0 and iron deficiency anaemia. Initial blood products and vitamin K treatment corrected the INR temporarily, but the patient's haemoptysis returned, and his INR values continued to rise. Further investigation revealed celiac disease with fat malabsorption, leading to vitamin K malabsorption and along with a previously prescribed antiplatelet aggregation therapy, this led to diffuse alveolar haemorrhage. A gluten-free diet and vitamin supplementation normalised the patient's INR and stopped the bleeding. This case highlights the importance of considering celiac disease in unexplained coagulopathies and the effectiveness of dietary management.
Learning points: Celiac disease can cause severe coagulopathy due to fat malabsorption and vitamin K deficiency.High suspicion is required for atypical presentations of celiac disease.A gluten-free diet is essential for managing celiac disease and normalising coagulation profiles.
乳糜泻是一种常见的自身免疫性疾病，可因维生素 K 吸收不良而导致脂肪吸收不良和凝血功能障碍。一名 64 岁的男性患者出现咯血和严重贫血（血红蛋白 6 g/dl）。尽管之前的凝血检查结果正常，但入院实验室检查发现其国际正常化比值（INR）为 7.0，并伴有缺铁性贫血。最初的血制品和维生素 K 治疗暂时纠正了 INR，但患者再次咯血，INR 值继续上升。进一步检查发现，患者患有乳糜泻并伴有脂肪吸收不良，导致维生素 K 吸收不良，再加上之前服用的抗血小板聚集疗法，导致了弥漫性肺泡出血。无麸质饮食和维生素补充剂使患者的 INR 恢复正常并止住了出血。本病例强调了在不明原因的凝血病中考虑乳糜泻的重要性以及饮食管理的有效性：学习要点：乳糜泻可因脂肪吸收不良和维生素 K 缺乏而导致严重的凝血功能障碍，因此需要高度怀疑乳糜泻的不典型表现。
期刊介绍：
The European Journal of Case Reports in Internal Medicine is an official journal of the European Federation of Internal Medicine (EFIM), representing 35 national societies from 33 European countries. The Journal''s mission is to promote the best medical practice and innovation in the field of acute and general medicine. It also provides a forum for internal medicine doctors where they can share new approaches with the aim of improving diagnostic and clinical skills in this field. EJCRIM welcomes high-quality case reports describing unusual or complex cases that an internist may encounter in everyday practice. The cases should either demonstrate the appropriateness of a diagnostic/therapeutic approach, describe a new procedure or maneuver, or show unusual manifestations of a disease or unexpected reactions. The Journal only accepts and publishes those case reports whose learning points provide new insight and/or contribute to advancing medical knowledge both in terms of diagnostics and therapeutic approaches. Case reports of medical errors, therefore, are also welcome as long as they provide innovative measures on how to prevent them in the current practice (Instructive Errors). The Journal may also consider brief and reasoned reports on issues relevant to the practice of Internal Medicine, as well as Abstracts submitted to the scientific meetings of acknowledged medical societies.
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