Adult-Onset Atypical Coeliac Disease Presenting with Severe Anaemia and Hidradenitis Suppurativa: A Case Report

Background: Coeliac disease is an autoimmune disease causing intestinal mucosal damage in response to dietary gluten resulting in malabsorption. It is a rarity in Sri Lanka and southern Asia possibly due to the low gluten consumption. This report is of a young female who presented with severe anaemia and hidradenitis suppurativa and was found to have coeliac disease. It is the first serologically confirmed adult case of the disease reported from Sri Lanka. Case presentation: A 23-year-old female presented with a history of an acute febrile illness associated with cough for about 24 hours. She gave a background history of altered bowel habits for 2 years. A mixed deficiency anaemia was detected, and endoscopy, serology and histological tests confirmed a diagnosis of coeliac disease. She was successfully treated with a gluten free diet. She also had hidradenitis suppurativa which subsided with a gluten-free diet. Conclusion: This case highlights an atypical presentation of anemia in coeliac disease in a population with low disease expression. Association of hidradenitis suppurativa with gluten hypersensitivity is an area of recent interest and complete resolution of the skin eruption occurred with a gluten free diet.