Celiac crisis, transient hypertransaminasemia and positive smooth muscle antibodies (SMA): A celiac disease case report

Celiac crisis (CC) is a rare complication of celiac disease (CD), usually observed in younger children with unrecognized CD or poor compliance with a gluten‐free diet (GFD). We present a case of celiac crisis in a 3‐year‐old girl who was recently diagnosed with celiac disease. She was referred to our clinic with anasarca, tetany, and severe malnutrition, with hypokalemia, hypocalcemia, hypomagnesemia, and hypoalbuminemia. During hospitalization, she presented hypertransaminasemia with positive anti‐actin smooth muscle antibodies (SMA). Abdominal ultrasound and liver biopsy were normal, excluding autoimmune hepatitis. Liver involvement is a common CD extraintestinal manifestation and cryptogenic form is the most common. SMA positivity could be associated with a systemic immune cross reaction. Our patient normalized liver values after 2 months of GFD.