A rare case report of celiac disease: Hypoglycemic coma in a nondiabetic patient

Abstract

Rationale: Celiac disease (CD) is an autoimmune disorder triggered by gluten ingestion in genetically predisposed individuals, leading to small intestinal damage and malabsorption. While classic gastrointestinal symptoms such as diarrhea and weight loss are well-documented, extraintestinal manifestations, including neurological and endocrine abnormalities, are increasingly recognized. However, hypoglycemic coma as a presenting feature of CD is exceedingly rare, particularly in nondiabetic individuals.

Patient concerns: A 24-year-old Caucasian male, recently relocated to Taiwan for academic studies, presented with progressive weight loss, chronic diarrhea, generalized weakness, and dizziness over 3 months. His symptoms culminated in a hypoglycemic coma, prompting emergency medical attention. Laboratory evaluations ruled out common causes of hypoglycemia, and further assessment was pursued to identify an underlying etiology.

Diagnoses: Initial serological testing revealed a positive anti-deamidated gliadin peptide immunoglobulin A despite a negative anti-tissue transglutaminase immunoglobulin A. Subsequent endoscopic biopsy confirmed CD with Marsh type I histopathological changes.

Interventions and outcomes: The patient was prescribed a strict gluten-free diet, leading to symptom resolution, weight recovery, and stabilization of blood glucose levels over follow-up.

Lessons: This case underscores the importance of considering CD in the differential diagnosis of unexplained hypoglycemia, particularly in individuals with concurrent gastrointestinal symptoms. It also highlights the potential challenges of living with undiagnosed CD in regions where gluten labeling and dietary awareness may be inconsistent. Early recognition and dietary intervention are crucial in preventing severe complications associated with CD.

Keywords: celiac disease; hypoglycemic coma; non-diabetes.

Figure 1.

Endoscopic biopsy of the duodenal intestine revealed normal villi structure and no crypt hyperplasia, but mild lymphocytic infiltration, which was consistent with celiac disease, Marsh classification type I histopathological changes.