A 42-year-old woman had a long history of mouth ulcers but no gastrointestinal symptoms. Lab tests diagnosed celiac disease, suggesting that the oral lesions are a sign of a chronic immune disorder. Once the woman went on a gluten-free diet, the ulcers resolved.
“Clinicians should remember that the absence of gastrointestinal symptoms does not exclude a diagnosis of celiac disease,” wrote study author Richard J. Vargoa, MD, of A.T. Still University in Kirksville, Missouri.
Worldwide, an estimated 1 in 100 people suffer from celiac disease, a condition in which eating gluten damages the small intestine. Despite the high prevalence of the disease, only about 30% are properly diagnosed, according to the Celiac Disease Foundation.
A 42-year-old woman with aphthous-like ulcers
The woman had multiple aphthous-like ulcers on the keratinized and nonkeratinized oral mucosa, most commonly on the dorsum of the tongue. The ulcers were chronic and had failed to respond to treatment, including avoiding sodium lauryl sulfate-containing toothpastes. According to the report, she did not report any systemic symptoms, including any gastrointestinal issues.
In addition to the ulcers, an oral examination revealed marked opacities consistent with enamel hypoplasia on her teeth. Because of these symptoms, she was referred for lab tests to determine if there was a systemic disorder, Vargoa wrote.
She tested positive for IgA tissue transglutaminase antibodies (>250.0 U/mL (> or = 15.0 U/mL)) and IgG tissue transglutaminase antibodies (18.8 U/mL (> or = 15.0 U/mL)). Endoscopy confirmed the diagnosis of celiac disease.
Once she went on a gluten-free diet, the ulcers resolved. They only returned when she accidentally ingested gluten.
“Clinicians should be aware that multiple aphthous-like ulcerations may indicate an underlying systemic disease, especially if they involve the keratinized oral mucosa,” Vargoa writes.