18 - World Journal of Gastroenterology

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Makay O et al . ectopic fascioliasis in the colon 2635 Un cas de distomatose pulmonaire autochtone. Rev Fr Mal Resp. 1975; 3: 579-588 5 Arjona R, Riancho JA, Aguado JM, Salesa R, Gonzalez-Macias J. Fascioliasis in developed countries: a review of classic and aberrant forms of the disease. Medicine (Baltimore) 1995; 74: 13-23 6 Acosta-Ferreira W, Vercelli-Retta J, Falconi LM. Fasciola hepatica human infection. Histopathological study of sixteen cases. Virchows Arch A Pathol Anat Histol 1979; 383: 319-327 7 Park CI, Kim H, Ro JY, Gutierrez Y. Human ectopic fascioliasis in the cecum. Am J Surg Pathol 1984; 8: 73-77 8 Pulpeiro JR, Armesto V, Varela J, Corredoira J. Fascioliasis: findings in 15 patients. Br J Radiol 1991; 64: 798-801 9 Yamada T, Alpers DH, Owyang C, Powell DW. Textbook of gastroenterology, Volume II. Parasitic diseases: Helminths. J.B. Lippincott Company, Philadelphia, 1991: 2131-2132 10 Rivero MA, Marcial MA. Biliary tract disease due to Fasciola hepatica: report of a case. Bol Asoc Med P R 1989; 81: 272-274 11 King CH, Mahmoud AAF. Schistosoma and other trematodes. In: Gorbach SL, Bartlett JG, Blacklow NR, editors. Infectious diseases. Philadelphia, PA: W.B. Saunders, 1992: 2015-2021 12 Takeyama N, Okumura N, Sakai Y, Kamma O, Shima Y, Endo K, Hayakawa T. Computed tomography findings of hepatic lesions in human fascioliasis: report of two cases. Am J Gastroenterol 1986; 81: 1078-1081 13 Barrett-Conner E. Fluke infections. In: Braude AI, editor. Infectious diseases and medical microbiology. 2nd ed. Philadelphia, PA: W. B Saunders 1986: 979-982 14 Knobloch J. Human fascioliasis in Cajamarca/Peru. II. Humoral antibody response and antigenaemia. Trop Med Parasitol 1985; 36: 91-93 15 Han JK, Choi BI, Cho JM, Chung KB, Han MC, Kim CW. Radiological findings of human fascioliasis. Abdom Imaging 1993; 18: 261-264 16 Kabaalioglu A, Cubuk M, Senol U, Cevikol C, Karaali K, Apaydin A, Sindel T, Luleci E. Fascioliasis: US, CT, and MRI findings with new observations. Abdom Imaging 2000; 25: 400-404 17 Han JK, Han D, Choi BI, Han MC. MR findings in human fascioliasis. Trop Med Int Health 1996; 1: 367-372 18 Catchpole BN, Snow D. Human ectopic fascioliasis. Lancet 1952; 2: 711-712 19 Trudgett A, Anderson A, Hanna RE. Use of immunosorbentpurified antigens of Fasciola hepatica in enzyme immunoassays. Res Vet Sci 1988; 44: 262-263 20 Kaplan M, Kuk S, Kalkan A, Demirdag K, Ozdarendeli A. Fasciola hepatica seroprevalence in the Elazig region. Mikrobiyol Bul 2002; 36: 337-342 21 Yilmaz H, Godekmerdan A. Human fasciolosis in Van province, Turkey. Acta Trop 2004; 92: 161-162 S- Editor Liu Y L- Editor Alpini GD E- Editor Liu Y www.wjgnet.com
PO Box 2345, Beijing 100023, China World J Gastroenterol 2007 May 14; 13(18): 2636-2638 www.wjgnet.com World Journal of Gastroenterology ISSN 1007-9327 wjg@wjgnet.com © 2007 The WJG Press. All rights reserved. CASE REPORT Celiac disease manifested by polyneuropathy and swollen ankles Zlatko Djuric, Borislav Kamenov, Vuka Katic Zlatko Djuric, Children’s Hospital, Department of Gastroenterology, University of Nis School of Medicine, Nis, Serbia Borislav Kamenov, Children’s Hospital, Department of Immunology, University of Nis School of Medicine, Nis, Serbia Vuka Katic, Institute of Pathology, University of Nis School of Medicine, Nis, Serbia Correspodence to: Zlatko Djuric, PhD, Children’s Hospital, Department of Gastroenterology, University of Nis School of Medicine, Dr. Zoran Djindjic Blv. 48, Nis 18000, Serbia. zldjuric@yahoo.com Telephone: +381-18-231922 Fax: +381-18-231922 Received: 2007-03-10 Accepted: 2007-03-26 Abstract A 27-year-old male started to have his ankles swollen during his military service. He was examined at a military hospital where electromyoneurography showed the signs of distal sensory-motor polyneuropathy with axon demyelinization and weak myopathic changes, whereas histopathological examination of gastrocnemius muscle biopsy revealed some mild and nonspecific myopathy. Besides, he was found to have subcutaneous ankle tissue edemas and hypertransaminasemia. Due to these reasons, he was dismissed from the military service and examined at another hospital where bone osteodensitometry revealed low bone mineral density of the spine. However, his medical problems were not resolved and after the second discharge from hospital he was desperately seeing doctors from time to time. Finally, at our institution he was shown to have celiac disease (CD) by positive serology (antitissue transglutaminase and antiendomysial antibodies) and small bowel mucosal histopathological examination, which showed total small bowel villous atrophy. Three months after the initiation of gluten-free diet, his ankle edema disappeared, electromyoneurographic signs of polyneuropathy improved and liver aminotransferases normalized. Good knowledge of CD extraintestinal signs and serologic screening are essential for early CD recognition and therapy. © 2007 The WJG Press. All rights reserved. Key words: Celiac; Polyneuropathy; Swollen ankles Djuric Z, Kamenov B, Katic V. Celiac disease manifested by polyneuropathy and swollen ankles. World J Gastroenterol 2007; 13(18): 2636-2638 http://www.wjgnet.com/1007-9327/13/2636.asp www.wjgnet.com INTRODUCTION Celiac disease (CD) is a genetically determined autoimmune enteropathy induced by gluten ingestion. CD patients can have typical symptoms (chronic diarrhea and malabsorbtion), extraintestinal symptoms, or they can be symptom-free. Extraintestinal clinical signs and symptoms can be diverse. They are increasingly recognized as common CD clinical manifestations. Neurological manifestations are estimated to occur in 7%-10% of the affected patients [1,2] . Peripheral neuropathy is most commonly found among them [3] . CASE REPORT A 27-year-old male started to have edematous and painful ankles during his military service. His history revealed that a week before, he had been treated with penicillin due to his sore throat and fever. He was allergic to a bee sting. On admission to a local military hospital, he was noted to have gracile body and thoracical spine kyphoscoliosis. His ankles were edematous, pale and painful to touch. Peripheral pulses on both legs were weaker than normal. Neurological examination showed decreased sensibility to touch, pain and temperature on distal parts of both calfs. Vibration sense was preserved. Deep tendon reflexes were weaker than normal. His gait and heel-chin test were normal while Romberg sign was negative. Laboratory tests showed normal erythrocyte sedimentation rate, c-reactive protein and complete blood count values. Biochemistry revealed normal creatine kinase while alanine aminotransferase (100, normal 5-35 U/L) and aspartate aminotransferase (118, normal 5-40 U/L) were elevated. All other liver function tests, including serum albumin, were normal. Antistreptolysin O antibodies titer, Waaler-Rose test and rheumatoid factor were negative. Urine analysis, urine proteins, and creatinine clirens were normal. Chlamydia trachomatis and mycoplasma were not detected by urethral swabs. Hepatitis Bs antigen, anti-hepatitis C viral antibodies and ELISA test on adenoviruses, cytomegalovirus, Ebstein-Barr virus and Borrellia burgdorferi were all negative. X-rays of both ankles were unremarkable. Ultrasound showed lymphoid retention in both ankles’ subcutaneous tissue regions (more visible on right ankle) without signs of inflammation in joints. Both ankles’ magnetic resonance imaging (MRI) showed diffuse edemas around the joints (more prominent on the right) without any signs of synovitis and tendonitis. Doppler ultrasound revealed normal blood flow in both legs. Electromyoneurography displayed
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18 - World Journal of Gastroenterology

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