RESUMO
Celiac disease (CD) is an immune-mediated enteropathy and is a rare disease in Asia, including in Korea. However, the ingestion of wheat products, which can act as a precipitating factor of CD, has increased rapidly. CD is a common cause of malabsorption, but many patients can present with various atypical manifestations as first presented symptoms, including anemia, osteopenia, infertility, and neurological symptoms. Thus, making a diagnosis is challenging. We report a case of CD that mimicked amyotrophic lateral sclerosis (ALS). The patient was a sexagenary man with a history of progressive motor weakness for 2 years. He was highly suspected as having ALS. During evaluation of his neurological symptoms, esophagogastroduodenoscopy (EGD) was performed because he had experienced loose stools and weight loss for the previous 7 months. On EGD, the duodenal mucosa appeared smooth. A biopsy revealed severe lymphoplasma cell infiltration with flattened villi. His serum endomysial antibody (immunoglobulin A) titer was 1:160 (reference, <1:40). Finally, he was diagnosed as having CD, and a gluten-free diet was immediately begun. At a 4-month follow-up, his weight and the quality of his stool had improved gradually, and the neurological manifestations had not progressed.
Assuntos
Humanos , Esclerose Lateral Amiotrófica , Anemia , Ásia , Biópsia , Doenças Ósseas Metabólicas , Doença Celíaca , Diagnóstico , Dieta Livre de Glúten , Ingestão de Alimentos , Endoscopia do Sistema Digestório , Seguimentos , Infertilidade , Coreia (Geográfico) , Síndromes de Malabsorção , Mucosa , Manifestações Neurológicas , Fatores Desencadeantes , Doenças Raras , Triticum , Redução de PesoRESUMO
No abstract available.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias dos Ductos Biliares/complicações , Ductos Biliares Intra-Hepáticos/química , Biópsia , Colangiocarcinoma/complicações , Diagnóstico Diferencial , Febre/diagnóstico , Imuno-Histoquímica , Leucocitose/diagnóstico , Fígado/química , Abscesso Hepático Piogênico/diagnóstico , Imageamento por Ressonância Magnética , Síndromes Paraneoplásicas/diagnóstico , Valor Preditivo dos Testes , Tomografia Computadorizada Espiral , Biomarcadores Tumorais/análiseRESUMO
Atypical antipsychotics, which have better efficacy and fewer side effects compared to first-generation antipsychotics, are being used increasingly for the treatment of schizophrenia. However, adverse events such as weight gain, diabetes mellitus and abnormal lipid profile have been reported in patients treated with these agents. Diabetic ketoacidosis (DKA) is a rare side effect of atypical antipsychotics, but deserves attention due to its severity. Although various atypical antipsychotics have been reported as causing DKA, there have been no reports showing an association with DKA and paliperidone, which is a recently developed antipsychotic agent. Here, we report two cases of DKA in patients with paliperidone therapy. Both cases had no history of diabetes before use of paliperidone, and DKA was manifested within 2 years of starting paliperidone therapy. Like other atypical antipsychotics, use of paliperidone warrants monitoring for metabolic derangements including DKA.