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Reversal of IgM deficiency following a gluten-free diet in seronegative celiac disease |
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| Authors: | Lucia Montenegro Domenico Piscitelli Floriana Giorgio Claudia Covelli Maria Grazia Fiore Giuseppe Losurdo Andrea Iannone Enzo Ierardi Alfredo Di Leo Mariabeatrice Principi |
| Affiliation: | Lucia Montenegro, Domenico Piscitelli, Floriana Giorgio, Claudia Covelli, Maria Grazia Fiore, Giuseppe Losurdo, Andrea Iannone, Enzo Ierardi, Alfredo Di Leo, Mariabeatrice Principi, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy;Alfredo Di Leo, Gastroenterology Unit, Policlinico Hospital, 70124 Bari, Italy |
| Abstract: | Selective IgM deficiency (sIGMD) is very rare; it may be associated with celiac disease (CD). We present the case of an 18-year-old man with sIGMD masking seronegative CD. Symptoms included abdominal pain, diarrhea and weight loss. Laboratory tests showed reduced IgM, DQ2-HLA and negative anti-transglutaminase. Villous atrophy and diffuse immature lymphocytes were observed at histology. Tissue transglutaminase mRNA mucosal levels showed a 6-fold increase. The patient was treated with a gluten-free diet (GFD) and six months later the symptoms had disappeared, the villous architecture was restored and mucosal tissue transglutaminase mRNA was comparable to that of healthy subjects. After 1 year of GFD, a complete restoration of normal IgM values was observed and duodenal biopsy showed a reduction of immature lymphocytes and normal appearance of mature immune cells. |
| Keywords: | Selective IgM deficiency Seronegative celiac disease Tissue transglutaminase Gluten-free diet |