Celiac crisis in a 19-month-old: the importance of repeating testing in cases of high clinical suspicion

Key words: Celiac crisis, Celiac disease, Serologic testing

Celiac disease (CD) is an autoimmune disorder that may present with non-specific gastrointestinal symptoms. A serious, potentially lethal complication of CD is celiac crisis (CC), marked by severe diarrhoea, vomiting, dehydration and metabolic disorders. CD diagnosis in children relies on serological tests for anti-endomysium IgA antibodies and anti-transglutaminase IgA antibodies. However, false negatives may occur due to age, concomitant use of drugs, or technical errors. The paper reports the case of a 19-month-old child with severe symptoms despite a former negative serological screening. High clinical suspicion led to repeat the test, which confirmed CD. After starting a gluten-free diet, the child improved rapidly, gained weight and normalised bowel movements. This case illustrates the diagnostic challenges of CD and its most serious complication (CC) in young children and emphasises the need for continuing testing when symptoms persist, even with initial negative results. Timely diagnosis is crucial to prevent serious complications and prescribe an appropriate diet.