Anasua Deb, MD, PhD1, Nurlan Aliyev, MD2, Kathryn Hutchins, MD, FACG1 1University of Nebraska Medical Center, Omaha, NE; 2University of Nebraska Medical Center, Elkhorn, NE Introduction: In asymptomatic patients with underlying Celiac disease (CD), the clue to the initial diagnosis can be through laboratory detection of vitamin malabsorption. We describe a patient whose CD was diagnosed after her vitamin A malabsorption was unmasked during treatment for an unrelated disease.
Case Description/
Methods: A 66-year-old female was referred for evaluation of vitamin A malabsorption. She had a 15-year history of chronic skin rashes and was diagnosed with stage III folliculotropic mycosis fungoides seven years prior. Her past medical history includes hypertension and ANA-positive inflammatory arthritis managed with losartan, hydroxychloroquine and low-dose prednisone, as well as surgical resection of an ovarian adenofibroma. Her mycosis fungoides had been treated with multiple modalities including UVB therapy (discontinued due to lack of response), bexarotene (discontinued due to hypertriglyceridemia), mogamulizumab (discontinued due to lack of response) and Acitretin with topical tretinoin cream. During Acitretin therapy, a low serum vitamin A level (298 mcg/L) was noted. Oral vitamin A supplementation produced inadequate response. Parenteral vitamin A injections raised her level to 477 mcg/L, but levels declined again upon cessation (377, 313 mcg/L).
Workup for malabsorption revealed normal pancreatic elastase ( >800), normal CFTR gene expression and slightly elevated fecal calprotectin (142 mcg/g). Vitamin E and K levels were at the low-normal range; iron, B12 and folate were normal. Notably, serum tissue transglutaminase IgA was significantly elevated (400.5 FLU), strongly suggesting CD as a possible cause of her vitamin A malabsorption. The patient is waiting for an endoscopic evaluation with biopsies for confirmation. Discussion: Micronutrient deficiencies are a common manifestation of CD and may precede gastrointestinal symptoms. Iron, vitamin D, and zinc deficiencies are most frequently reported, though vitamin A deficiency is seen in up to 7.5% cases. In this patient, vitamin A deficiency — identified during acitretin therapy — was the initial clue to CD. The vitamin A deficiency was incidentally found after treatment with acitretin during routine monitoring of vitamin A levels. Inadequate response to oral vitamin A supplementation suggests ongoing malabsorption. This case highlights the importance of considering CD in patients with unexplained vitamin deficiencies, even in the absence of gastrointestinal complaints.
Figure: Skin lesion characteristic of Mycosis fungoides
Disclosures: Anasua Deb indicated no relevant financial relationships. Nurlan Aliyev indicated no relevant financial relationships. Kathryn Hutchins indicated no relevant financial relationships.
Anasua Deb, MD, PhD1, Nurlan Aliyev, MD2, Kathryn Hutchins, MD, FACG1. P4131 - Incidental Discovery of Celiac Disease in a Patient with Mycosis Fungoides, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
