A 35-year-old woman with no history of interest presented with abdominal pain, diarrhea and constitutional syndrome, which appeared a few weeks after her first delivery. The previous pregnancy had passed without complications.
It is studied in the gastrointestinal tract section, being diagnosed with CD when meeting diagnostic criteria: 1) title of anti-transglutaminase antibodies; and 2) elevated intestinal biopsy with hyperplasia of the duodenum.
Shortly after the clinical examination, the patient presented with polyarthralgia of the median joint, predominantly pruritic and tarsal, together with cutaneous lesions and micropapulas.
They send her to Nephrology for proteinuria of +++.
On physical examination: blood pressure 104/76 mmHg, BMI 27, minimal edema in lower limbs and papules in elbows and arms.
Blood count and coagulation were normal, creatinine 0.9 mg/dl, total cholesterol 238 mg/dl, triglycerides 104 mg/dl, total protein 6.5 g/dl and albumin 3.6 g/dl. Anticardiolipin antibodies anticardiolipin:
Serology against HBV, HCV and HIV was negative.
Anti-tissue transglutaminase IgA antibodies positive titre 800 U/ml (normal <7 U/ml).
Urine: proteins 4.4 g/day and sediments with 5 episodes per field.
Renal ultrasound is normal.
Persistent nephrotic proteinuria persisted for several weeks. Percutaneous renal biopsy was performed, resulting in stage 2 MN without vascular or interstitial lesions.
He received treatment with gluten-free diet and other conservative measures with statin, aspirin dosage, enalapril and losartan, with no initial response.
However, at 12 months of follow-up, there was simultaneous negativization of antitransglutaminase antibodies and complete remission of proteinuria, as shown in Figure 1.
During this time he has not presented other data of systemic disease, except increased levels of TSH 6.6 μU/ml, with FT4 1.1 ng/dl and negative antithyroglobulin and antimicrosomal antibodies.
