Holmes-Adie syndrome, autoimmune hepatitis and celiac disease: A case report

Timea Csak, Aniko Folhoffer, Andrea Horvath, Judit Halász, Csaba Diczházi, Zsuzsa Schaff, Ferenc Szalay

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A 35-year-old female patient presented with the following symptoms of Holmes-Adie syndrome: photophobia, enlargement of the left pupil unresponsive to light, Achilles areflexia. The pilocarpine test was positive. No tumor or other neurological abnormality was found. She had a 19-year history of autoimmune hepatitis. Flares up were observed following each 3 deliveries. At age of 31 she presented with diarrhea and weight loss. Abdominal tumor was detected by ultrasound. The surgically removed tumor was histologically a benign mesenteric multicystic lymphangioma. Simultaneously, celiac disease was diagnosed. Gluten-free diet resulted in a significant improvement of celiac disease, but not of autoimmune hepatitis. Autonomic neuropathy was proven by standard cardiovascular tests. The patient was a homozygous carrier for HLA DQ2 antigen characteristic for celiac disease and heterozygous for HLA DR3 B8 frequent in autoimmune liver diseases. Our novel observation on association of Holmes-Adie syndrome with autoimmune hepatitis and celiac disease is suggestive for a common immunological background for all three entities present in a patient with mesenteric multicystic lymphangioma.

Original languageEnglish
Pages (from-to)1485-1487
Number of pages3
JournalWorld journal of gastroenterology
Issue number9
Publication statusPublished - Mar 7 2006



  • Autoimmune hepatitis
  • Autonomic neuropathy
  • Celiac disease
  • Holmes-Adie syndrome
  • Mesenteric lymphangioma

ASJC Scopus subject areas

  • Gastroenterology

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