Celiac crisis in a patient with chronic lymphocytic leukemia and hypogammaglobulinemia

Celiac crisis is an acute, fulminant form of celiac disease manifesting with severe diarrhea, metabolic and electrolyte abnormalities, and weight loss. It is mostly seen in children, and there are very few reports in adults. We present a 67-year-old patient with chronic lymphocytic leukemia (CLL) who presented with weight loss of 40 pounds, severe diarrhea, hypoalbuminemia and hypokalemia. The patient was immunosuppressed with hypogammaglobulinemia, which is common in CLL. Thus, the patient had negative serological studies for celiac disease. An endoscopic evaluation and HLA typing supported the diagnosis of celiac disease. Although the differential diagnosis was broad, exclusion of other etiologies for diarrhea, prompt diagnosis of celiac disease and initiation of gluten-free diet resolved the crisis. This is the first such report of a patient presenting with celiac crisis on a background of hypogammaglobulinemia.