Clinical Case Study: AN UNUSUAL PRESENTATION OF CELIAC DISEASE IN A MIDDLE-AGED MAN TREATED FOR HYPERTENSION A CASE REPORT
Jirí Holý MD
Zsolt Keczkemethy MD
Jana Prádná MD
Pavel Havránek MD
LeAnne Vitito MS, RN, CGRN, APRN; Department Editor

$3.95
Gastroenterology Nursing
February 2012 
Volume 35  Number 1
Pages 65 - 68
 
  PDF Version Available!

ABSTRACT
Contractions of striated muscles are acute symptoms requiring urgent treatment as a rule. If the treatment must continue and the reason of muscular contractions is unknown, hospitalization is necessary. There is a wide spectrum of possible reasons for this disorder including primary neurologic disorder. Muscular contractions can be caused by mineral imbalance, particularly hypokalemia and hypocalcemia. Mineral imbalance can be caused by malabsorption owing to a chronic disease- celiac disease (CD). It can be difficult and take time to diagnose CD, especially when gastrointestinal symptoms are not in the foreground.We report on a 52-year-old man with hypertension who was admitted to the department of neurology for paresthesia of the upper and lower extremities, and muscular contractions of the upper extremities and his mimic muscles. These contractions occurred even during the examination at admission.The patient managed his hypertension with amlodipine (Zorem) 5 mg daily and lisinopril (Diroton) 20 mg daily. The patient was an apprentice trained toolmaker and worked as a foreman. He was married. He smoked 15 cigarettes a day. One and half year before the admission, he suffered an injury caused by electricity from his household washing machine. Laboratory examination, including basic electrolytes, performed at that time did not reveal any important changes and the injury apparently had no consequences.The patient, however, complained of prolonged borderline diarrhea (approximately three to four loose stools daily). During 1 year, he lost weight from 176 down to 145.5 pounds. The patient did not complain of appetite loss. One month before the admission to the department of neurology, he was examined in the gastroenterologic department because of diarrhea and enterorrhagia (intestinal hemorrhage). Oesophagogastroduodenoscopy revealed mild oesophagitis. Colonoscopy revealed anal fissure and internal hemorrhoids.During the hospitalization in the department of neurology,

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