Adult coeliac disease and sarcoidosis: a rare association

Abstract

The authors report the case of a 31-year-old woman
with a paucisymptomatic form of adult coeliac
disease, diagnosed in May 95, based essentially on
laboratory findings (ferropenic anaemia, low serum
folate, positive antigliadin and endomysial
antibodies) and histopathological grounds (subtotal
villous atrophy). Improvement was seen following
adherence to a gluten-free diet.
In May 98 the patient presented with sudden onset
of fever. Oligoarthritis and erythema nodosum
developed; bilateral hilar lymphadenopathy was
found, symptoms and signs typical of acute
sarcoidosis – Löfgren syndrome. The diagnosis was
supported by bronchoalveolar lavage and lymph
node histology. Other systemic disorders with a
similar presentation were excluded.
Several autoimmune diseases have been associated with coeliac disease, such as thyroid disorders,
Addison’s disease, primary biliary cirrhosis, IgA
nephropathy and insulin-dependent diabetes
mellitus. The association between sarcoidosis and
coeliac disease has been rarely described in the
literature (only ten cases to date).
The immunological mechanisms, accepted as
responsible for this association, are discussed