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CASE REPORT. Dr Veselinka Djurisic Institute for Children ’s Disease s Montenegro. Female infant, 8 month old; Admitted to hospital due to: Diarrhoea ; Metabolic disbalance; With sings of enteropathy. . History of Present Illness.

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Case report


Dr VeselinkaDjurisic

Institute for Children’s Diseases


Case report

History of present illness
History of Present Illness

  • 15 min before admission to hospital present with sudden abdominal cramping, cyanosis of limbs, she was lethargic, with drooping head.

  • Day before admision, she was sleepless, agitated, inconolably crying, with non bilious, non-projectile vomiting (4 times/day), and she had 10 regular stools.

  • 9 days before she was addmited to hospital due to vomiting, diarrhoea and high fever.

Personal hystory
Personal hystory:

  • Third child from regular pragnancy and term delivery completed with caesarean section.

  • Birth weight: 2830 g; Birth length: 53 cm; AS 9

  • Breastfeeded 3 mo, after that continued adapted milk formula, 1 month later started mixed non-milk nutrition.

  • No history of allergy, regularly vaccinated

Family history
Family history

  • Older brother – convulsions trated with AET;

  • Father – epilepsy;

  • Mother – chronic enteropathy in childhood suggested gluten free diet, but she refused;

  • Grandfather – COPD;

Clinical finding
Clinical finding

  • Weight 7 kg

  • Agitated, crying, groaning, dehydrated, afebrile (36,7⁰C), hemodynamically stable;

  • Vital sings: RR 36/min, CF 136/min, spO2 93%;

  • Skin: pale, marble, with limbs cyanosis.

  • Left torticollis, slight axial hypotonia.

  • Normal auscultatory findings of lungs and heart .

  • Abdominal examination: abdominal distension ,soft and nontender, without tumefacts and organomegaly.

L aboratory findings
Laboratory findings

Case report


  • Stool culture, ova and parasite testing, Rotavirus and Adenovirus: NEGATIVE.

  • Stool: positive for Candida sp.

  • Urin culture: negative.

Radiology findings
Radiology findings

  • X-ray plain film

  • air-fluid levels

Radiology findings1
Radiology findings

  • Ultrasound revealed mass suspected to intussusception in right hemiabdomen:

    • Target sign (also known as the doughnut sign)

    • Pseudokidney sign

Radiology findings2
Radiology findings

  • Abdominal CT scan reveals dilated and fluid-filled loops of small bowel with air-fluid levelsthe classic ying-yang sign of an intussusceptum inside an intussuscipiens in right hemiabdomen.

Case report


  • Treated with antibiotics:

    • metronidazole

    • gentamicin

  • Corticosteroids:

    • methylprednisolone

  • H2 blockers:

    • ranitidine

  • Transfusion of fresh frozen plasma, 3 times

Case report

Conclusion introduced, but without any improvement.

  • Case of rare but serious clinical presentation of celiac crisis.

  • It is important to recognize that CD may present in “crisis.”

  • The possible precipitating factors in present patient are unrecognized coeliac disease, hypokalemia and previous infection.

Discussion introduced, but without any improvement.

  • Incidence of celiac disease is on rise in Montenegro.

  • Prevalence of CD is found to be........ dopuniti ukoliko postoje podaci.....

  • Celiac crisis is a life-threatening complication of CD.

  • Clinically, it is characterized by severe diarrhea, dehydration and metabolic disturbances like hypokalemia, hypomagnesemia, hypocalcemia, hypoproteinemia and metabolic acidosis.

Definition of celiac crisis
Definition of celiac crisis introduced, but without any improvement.

  • Acute onset or rapid progression of gastrointestinal symptoms attributable to celiac disease requiring hospitalization and/or parenteral nutrition along with at least 2 of the following:

Metabolic pathophysiology in celiac crisis
Metabolic pathophysiology in celiac crisis introduced, but without any improvement.

Case report

  • Celiac crisis may not respond to a gluten-free diet alone. In severely ill children with celiac crisis, the use of corticosteroids may cause dramatic improvement. *

  • Lloyd-Still described 3 cases of celiac crisis successfully treated with corticosteroids. **

  • The role of steroids now is controversial as gluten free and good nutritional diet are considered good enough to tide over the crisis ***

* Mihailidi E, Paspalaki P, Katakis E, Evangeliou A. Celiac Disease: A Pediatric Perspective. International Pediatrics 2003;18:141-8.

** Lloyd-Still JD, Grand RJ, Khaw KT, Shwachman H. The use of corticosteroids in celiac crisis. J Pediatr. 1972; 81: 1074-1081.

*** Walia A, Thapa BR. Celiac crisis. Indian Pediatr. 2005; 42: 1169

G razie per l attenzione
G In severely ill children with celiac crisis, the use of corticosteroids may cause dramatic improvementrazie per l'attenzione

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