Case Report

Factitious Diarrhea Masquerading as Refractory Celiac Disease

Authors: Rajesh N. Keswani, MD, Jenny Sauk, MD, Sunanda V. Kane, MD

Abstract

A 23-year-old female with a history of a histologically confirmed diagnosis of celiac disease was referred to our institution for refractory celiac disease for consideration of immunosuppressive therapy. Full workup revealed an elevated fecal magnesium level, and a concurrent diagnosis of laxative abuse was confirmed after discussion with the family. This case highlights the importance of considering factitious diarrhea in all patients admitted for refractory diarrhea, even those with documented underlying conditions.


Key Points


* Celiac disease is a genetically determined disease that almost always readily responds to a gluten-free diet.


* Refractory celiac disease is an uncommon disease, and is one of exclusion.


* Diagnosis of factitious diarrhea requires a high index of suspicion and should be considered in all patients admitted for refractory diarrhea, even those with a documented underlying condition.


* Stool magnesium concentration can be very helpful in establishing a diagnosis of factitious diarrhea.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Green PH, Jabri B. Coeliac disease. Lancet 2003; 362:383–391.
 
2. Trier J. Diagnosis of celiac sprue. Gastroenterology 1998;115:211–216.
 
3. Ciacci C, Mazzacca G. Unintentional gluten ingestion in celiac patients. Gastroenterology1998;115:243.
 
4. Ryan BM, Kelleher D. Refractory celiac disease. Gastroenterology 2000;119:243–251.
 
5. Donowitz M, Kokke FT, Saidi R. Evaluation of patients with chronic diarrhea. N Engl J Med 1995; 16:725–729.
 
6. Phillips S, Donaldson L, Geisler K. et al. Stool composition in factitial diarrhea: a 6-year experience with stool analysis. Ann Intern Med 1995; 15:97–100.
 
7. Fine KD, Santa Ana CA, Fordtran JS. Diagnosis of magnesium-induced diarrhea. N Engl J Med 1991; 324: 1012–1017.
 
8. Plumeri PA. The room search. J Clin Gastroenterol 1984;6:181–185.