Osteomalacia: atypical presentation of celiac disease

Abstract

The case of a 58 year woman with history of chronic pain, bone deformity and iron deficiency anemia, is presented. Hypocalcemia, hypophosphatemia, hyperparathyroidism and increased alkaline phosphatase levels with decreased vitamin D levels are detected. Endomysial and gliadin antibodies are present and celiac disease is confirmed by gastric videoendoscopy and biopsy. The oligosymptomatic type is one of the forms of presentation of celiac disease; which together with the subclinical presentation comprise 50% of cases. In this case, anemia with iron deficiency and advance stage osteomalacia were the clinical manifestations. Decreased absorption of calcium and vitamin D cause secondary hyperparathyroidism and osteomalacia. In this case, the advanced stage presents bone pain, deformity, and fractures, and these findings are partially reversed by treatment. We report this case due to the unusual presentation of this common disease in clinical practice, which requires increasing the index of clinical suspicion to promote early diagnosis.