Duodenal ulceration in a patient with celiac disease and plasminogen I deficiency: Coincidence or cofactors?

Gabor Veres, Ilma Korponay-Szabó, Erika Maka, Tibor Glasz, Petar Mamula, Maria Papp, Antal Dezsöfi, Andras Arató

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Celiac disease (CD) is a gluten-dependent inflammatory disease of the small bowel that affects up to 1% of the worldwide population. Despite severe mucosal abnormalities including total villous atrophy and autoantibody deposition, duodenal ulcer is not a feature of CD. However, a recent study found an elevated rate of peptic ulcer disease in patients with CD. Plasminogen deficiency (PLD) is an autosomal recessive disease that causes pseudomembranous lesions in different organs, but gastrointestinal involvement is rare. Here we report the case of a 6-year-old girl who had a sudden onset of hematemesis caused by duodenal ulcer. On the basis of mucosal atrophy, elevated celiac antibody levels, decreased plasminogen serum activity, and homozygous missense mutation R216H in the plasminogen gene, CD and PLD were diagnosed. This report is, to our knowledge, the first description of the 2 entities, and results of our double-immunofluorescent studies also suggest that both diseases may have a role in the ulceration process. Excessive amounts of fibrin deposition due to PLD caused the distortion of the vessels and was responsible for the unusual celiac immunoglobulin A and tissue transglutaminase 2 in vivo binding pattern. On the basis of this result, patients with CD and unknown cause of gastrointestinal ulcer may require investigation for PLD.

Original languageEnglish
Pages (from-to)e1302-e1306
JournalPediatrics
Volume128
Issue number5
DOIs
Publication statusPublished - Nov 2011

Keywords

  • Celiac disease
  • Duodenal ulcer
  • Plasminogen deficiency

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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