Case Report
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World J Gastroenterol. Feb 7, 2014; 20(5): 1357-1360
Published online Feb 7, 2014. doi: 10.3748/wjg.v20.i5.1357
A trichobezoar in a child with undiagnosed celiac disease: A case report
Iñaki Irastorza, Carlos Tutau, Juan Carlos Vitoria
Iñaki Irastorza, Juan Carlos Vitoria, Pediatric Gastroenterology and Nutrition Unit, University Hospital Cruces and School of Medicine, University of the Basque Country, 20018 Bilbao, Basque Country, Spain
Carlos Tutau, Pediatric Gastroenterology and Nutrition Unit, University Hospital Cruces, 48903 Barakaldo, Basque Country, Spain
Author contributions: Irastorza I, Tutau C, and Vitoria JC contributed equally to this work; Irastorza I and Vitoria JC designed the research and provided the discussion of the pathology; Irastorza I, Vitoria JC and Tutau C provided the discussion of the clinical features; Irastorza I and Tutau C contributed equally to the writing of the manuscript.
Correspondence to: Carlos Tutau, MD, Pediatric Gastroenterology and Nutrition Unit, University Hospital Cruces, Cruces Square 12, 48903 Barakaldo, Basque Country, Spain. carlos.tutaugomez@osakidetza.net
Telephone: +34-94-6006316 Fax: +34-94-6006316
Received: May 16, 2013
Revised: July 9, 2013
Accepted: July 17, 2013
Published online: February 7, 2014
Processing time: 279 Days and 22 Hours
Abstract

Celiac disease is a chronic, immune-mediated enteropathy caused by a permanent sensitivity to ingested gluten cereals that develops in genetically susceptible individuals. The classic presentation of celiac disease includes symptoms of malabsorption but has long been associated with cognitive, emotional, and behavioral disorders. We describe an 8-year-old patient with non-scarring alopecia and diagnosed with trichotillomania. Furthermore, she presented with a 3-year history of poor appetite and two or three annual episodes of mushy, fatty stools. Laboratory investigations showed a normal hemoglobin concentration and a low ferritin level. Serologic studies showed an elevated tissue immunoglobulin G anti-tissue transglutaminase level. A duodenal biopsy showed subtotal villous atrophy and crypt hyperplasia, and a large gastric trichobezoar was found in the stomach. Immediately after beginning a gluten-free diet, complete relief of trichotillomania and trichophagia was achieved. In this report, we describe a behavioral disorder as a primary phenomenon of celiac disease, irrespective of nutritional status.

Keywords: Celiac disease; Trichobezoar; Trichotillomania; Behavioral disorder; Malabsorption syndrome

Core tip: Celiac disease has been associated with trichotillomania and trichophagia but is always secondary to iron deficiency anemia. We describe a behavioral disorder as a primary phenomenon of celiac disease, irrespective of nutritional status.