CASE HISTORY – April 2010

Dermatitis herpetiformis as the only sign of coeliac disease. A case report and a literature review

Authors: Jaanika Ilisson, Terje Kukk, Mari Kivivare, Oivi Uibo

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Abstract

We present a case-report of a 11-year-old boy whose main complaint was small blistering rash on the intensely pruritic skin. The diagnosis of dermatitis herpetiformis was confi rmed 11 months after the rash was first noted. It was based on the typical rash and presence of granular IgA deposits in dermal papillae on direct immunof luorescence examination. Dermatitis herpetiformis is also known as the skin manifestation of coeliac disease. Although most patients do  not have any gastrointestinal complaints or symptoms, almost 90% of them have small bowel villous atrophy at the time dermatitis herpetiformis is diagnosed. Our patient had no gastrointestinal complaints or symptoms and his weight and growth dynamics was normal. The small bowel biopsy specimen revealed classical gluten-sensitive villous atrophy (Marsh IIIb). Treatment was started with a gluten-free diet and the rash and pruritus subsided within one week.