Case Report
An Abdominal Mass in a Child with IgA Deficiency: A Case Report
Maria Barbato1*, Ilaria Celletti1, Chiara Di Camillo1, Francesco Valitutti1, Stefania Leoni1, Vanessa Dionne2, Francesca Romana D’Attilia2, Alessandra De Grazia2 and Anna Clerico2
1Sapienza University of Rome, Department of Pediatric Gastroenterology and Liver Unit, Department of Pediatrics, Viale Regina Elena 324, 00161 Rome
2Sapienza University of Rome, Pediatric Oncology Unit, Department of Pediatrics, Viale Regina Elena 324, 00161 Rome
- *Corresponding Author:
- Maria Barbato
Paediatric Gastroenterology and Liver Unit
University Hospital Umberto I - Sapienza University of Rome
Viale Regina Elena 324 - 00161 Rome
Tel: +390649979257
Fax: +390649979325
E-mail: maria.barbato@uniroma1.it
Received date: February 27, 2014; Accepted date: March 19, 2014; Published date: March 26, 2014
Citation: Barbato M, Celletti I, Camillo C, Valitutti F, Leoni S, et al. (2014) An Abdominal Mass in a Child with IgA Deficiency: A Case Report. J Gastroint Dig Syst 4:180. doi:10.4172/2161-069X.1000180
Copyright: © 2014 Barbato M, et al. This is an open-access article distributed under the terms of the CreativeCommons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
Introduction: We describe for the first time the case of a one-year old girl admitted to our hospital on the suspicion of an abdominal tumor who finally received the diagnosis of celiac disease and IgA deficiency.
Case presentation: A one-year old girl was admitted to the Pediatric Emergency Care Unit for severe bloating, diarrhea and vomiting for one month; she had been febrile for the last three days. Clinical examination revealed no guarding, a bloated and tender abdomen, and a palpable mass in the umbilical region. Abdominal ultrasonography was then performed, which identified a retroperitoneal mass resembling a tumor; therefore, she was transferred to the Paediatric Oncology Unit for further evaluations. Although deficit of serum IgA delayed the diagnosis, IgG serological markers (anti-deamidated gliadin peptide and anti-transglutaminase antibodies) and duodenal biospy confirmed celiac disease. She was discharged after 23 days on a gluten free diet. The patient was in good health and thriving normally at 12-month follow-up.
Conclusion: Celiac disease can mimic several conditions whose differential diagnoses could be wide. In this case, both IgA deficiency and malnutrition could have led to multiple mesenteric lymphadenopathies, completely regressed once the gluten-free diet was started. If unrecognized, IgA deficiency can jeopardize CD diagnosis since anti-tissue transglutaminase and anti-endomysial antibodies are commonly tested as IgA antibodies. Physicians should always be aware of this association and ascertain IgA serum levels when assessing CD serological markers: if a IgA deficiency is present, demanding for specific IgG serological tests is then mandatory.
