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Table 1 Timeline of patient’s medical history

From: Celiac disease associated with aplastic anemia in a 6-year-old girl: a case report and review of the literature

  Past medical history
A 6-year-old girl with history of bruising and fever for 1 month and loose stools for 3 months. She was a known asthmatic. Her family history was unknown as she was an adopted child.
Hospital/out-patient visits Diagnostic tests Interventions
October 2013 Presented with bruises, undocumented fever, and eczematous rashes for 1 month. Petechiae all over the body. Loose stools daily for 3 months with loss of appetite. Hb 9.0 g/dl,
platelet 67 × 109/L,
MCV 75.3 fl,
MCH 24.2 pg.
Normal LFT, RFT, urine examination, and coagulation profile. Blood culture was sterile.
ANA titer was negative.
Chromosomal breakages was negative with 0.58 breaks/cell,
IgA tTG 370 IU/ml,
anti-gliadin antibodies 140 IU/ml.
Jejunal biopsy – complete villous atrophy with increased intraepithelial lymphocytes.
Antibiotics, packed red cells, and platelet support given.
Put on a gluten-free diet, supplemented with multivitamins, vitamin C, and iron.
She was discharged on day 17 of hospital stay with Hb 7.9 g/l,
TLC 2.5 × 109/l,
platelet count of 46 × 109/l, and gluten-free diet. Bone marrow biopsy was advised.
Noncompliant with yearly follow ups. Varying platelet levels from 34 × 109/L to 124 × 109/L. Gluten-free diet
October 2016 Nonproductive cough, fever, respiratory distress for 2 months.
History of recurrent infections over the year
Lung abscess and a cavitary lesion seen on HRCT.
Lung culture revealed Pseudomonas aeruginosa.
GeneXpert, galactomannan, and BDG antibodies were negative. A bone marrow trephine biopsy revealed hypocellular bone marrow.
She is planned for bone marrow transplantation.
Parents were counseled about the disease and treatment.
Managed with packed red cells, platelet support, and a gluten-free diet. She showed an increasing trend in platelet count.
  1. ANA antinuclear antibodies, BDG β-d-glucan, Hb hemoglobin, HRCT high-resolution computed tomography, LFT liver function test MCH mean corpuscular hemoglobin, MCV mean corpuscular volume, RFT renal function test, TLC total leukocyte count, tTG tissue transglutaminase