[Severe anemia in a young woman. Description of a rare coincidence].

HISTORY AND ADMISSION FINDINGS: A 25-year-old woman was admitted because of severe anemia and exercise-induced tachypnea and dyspnea. She had no gastrointestinal symptoms and reported no allergies. The family history did not reveal any obvious or familial disease.

DIAGNOSIS, TREATMENT AND COURSE: Whole blood analysis showed severe macrocytic anemia. The vitamin B12 level was reduced and biopsies revealed autoimmune gastritis and typical megaloblastic changes in the bone marrow. Gastroscopy showed marked mucosal atrophy as seen in celiac disease. Vitamin B12 was administered parenterally and she was put on a gluten-free diet.

CONCLUSION

The combination of autoimmune gastritis and celiac sprue is most likely a variant of the polyglandular autoimmune syndrome type 2. Early diagnosis, life-long gluten-free diet and vitamin B12 administration as well as appropriate aftercare prevent serious complications.