Celiac Disease in Association with Gilbert’s Syndrome

Excerpt

To the Editor: A 9-y-old girl presented with history of persistent yellowish discoloration of eyes and skin since birth and inadequate weight and height gain for 4 to 5 y. She was first admitted with icterus (total bilirubin 18.6 mg%, direct fraction 1.2 mg%) on day 4 of life and treated with single surface phototherapy. She redeveloped deep yellowish discoloration 3 d after discharge with total bilirubin level of 17.8 mg%. She responded to oral phenobarbitone with decline in total serum bilirubin level to 8.8 mg% within 48 h. The child was then lost to follow up but brought back at the age of 9 y, with persistent icterus and poor growth for past 4 to 5 y. Her weight was 19 kg (between -3SD to -2SD) and height was 110 cm (< -3SD). The mid parental height was 160 cm. The systemic examination was essentially unremarkable except icterus. Patient was found to have high levels of tissue Transglutaminase antibodies (tTG IgA: 330 U/ml). Upper gastrointestinal endoscopy demonstrated normal duodenal mucosa (Fig. 1). Duodenal biopsy (Fig. 2) suggested histopathological diagnosis of celiac disease (Marsh grade 3). Patient responded favorably to gluten free diet. The parents also informed about a male sibling born around 5 y back, who also had persistent yellowish discoloration of eyes and skin since birth.

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