<span lang="EN">A multisystemic presentation of celiac disease in an uninsured south Asian male

Background: Celiac disease (CD) is a chronic autoimmune enteropathy triggered by gluten ingestion in genetically susceptible individuals, presenting with both gastrointestinal and extraintestinal features. Early recognition remains a challenge, particularly in uninsured or immigrant populations where diagnostic access is limited.Case Presentation: We report a ۳۳-year-old South Asian male who presented to a free community clinic with a one-year history of diffuse abdominal pain, weight loss, and pruritic rashes. Laboratory testing revealed elevated tissue transglutaminase IgA antibodies, gamma-glutamyl transferase, significantly elevated hemoglobin A۱c and subclinical hypothyroidism. Shear-wave elastography indicated moderate hepatic fibrosis. The patient was counseled on a gluten-free diet, initiated on insulin and atorvastatin, and referred for gastroenterology evaluation.Discussion: This case illustrates the multisystemic impact of untreated CD, including metabolic, hepatic, dermatologic, and autoimmune thyroid manifestations. The coexistence of diabetes mellitus, thyroid dysfunction, and hepatic fibrosis underscores shared immunogenetic pathways involving HLA-DQ۲/DQ۸ and CTLA-۴. Diagnostic challenges included weak positive tissue transglutaminase IgA antibodies, compounded by socioeconomic barriers that limited access to biopsy and genotyping. Celiac disease should be considered in patients presenting with overlapping metabolic or autoimmune disorders, even when classic gastrointestinal symptoms are absent. In resource-limited settings, serologic testing combined with clinical response to a gluten-free diet offers a practical approach for timely diagnosis and management.

کلیدواژه ها:

celiac disease ، Autoimmune disorders ، Diabetes Mellitus ، Hypothyroidism ، Liver fibrosis