Muscular dystrophy misdiagnosed as hepatic disease in a child with coeliac disease

A 13-month-old boy presented with elevated serum aminotransferases and a flat small bowel mucosa indicating coeliac disease. He improved clinically on a gluten-free diet but serum aminotransferases continued to increase. This was found to be caused by an occult Duchenne muscular dystrophy. The case illustrates the fact that the finding of elevated serum aminotransferases in a coeliac child on a gluten-free diet should indicate that further investigations are needed to exclude coexisting disease.