Hepatitis B infection induced celiac disease in a young child with autoimmune hepatitis

Abstract

A 10-year-old girl having pain in her right hypochondrium was found to have a low hemoglobin along with iron deficiency anemia. Further investigations showed HBsAg positive with HBV DNA detected, viral load of 4×106 IU/mL, HBe Ag positive, HBc IgM negative. Her abdominal ultrasonography had no features of chronic liver disease and she was started on tab entecavir. After a month, she presented with loose watery stools and generalized weakness. Based upon her tissue transglutaminase (tTG) serology and distal duodenum biopsy she was diagnosed with celiac disease. Later on, she came presented again, this time with abdominal pain along with generalized weakness and was found to be antinuclear antibodies  (ANA) positive with a raised IgG. She was found to be compliant on her gluten free diet (GFD). Liver biopsy was done and had features of both autoimmune hepatitis and acute viral hepatitis. She was later started on steroids and kept on entecavir along with her GFD.