Cryptogenic Hypertransaminasemia Unmasking Silent Celiac Disease: A Case Report
Author(s):
Domenico Cirillo, Vittoria Gammaldi, Antonietta De Sena, Gianluigi Cuomo, Giuliana Vespere, Antonio Cozzolino, Vincenzo Nuzzo and Paolo Tirelli
Celiac hepatitis represents an underestimated cause of unexplained liver enzyme elevation, affecting approximately twenty-one percent of patients with celiac disease. We report the case of a fifty-year-old man presenting with persistent isolated hypertransaminasemia and nonspecific fatigue. After excluding common causes of liver dysfunction including viral hepatitis, autoimmune and metabolic liver diseases, celiac disease screening revealed markedly elevated anti-tissue transglutaminase IgA antibodies. Duodenal biopsy confirmed Marsh grade 3 villous atrophy, establishing the diagnosis. Complete normalization of transaminase levels occurred within three months of strict gluten-free diet adherence. This case underscores the importance of maintaining high diagnostic suspicion for celiac disease in patients with cryptogenic hypertransaminasemia, given the excellent therapeutic response to dietary intervention and the substantial underdiagnosis of this treatable condition in clinical practice.