Gluten-Induced Pancytopenia: A Pediatric Case Report and Literature Review

Abstract

We report the case of a nine-year-old boy who presented with severe pancytopenia and respiratory distress. His medical history was notable for pica, chronic epigastric pain, pallor, and intermittent vomiting. Initial laboratory investigations revealed profound anemia (Hemoglobin (Hb) 2 g/dL), neutropenia, thrombocytopenia, and significant deficiencies in vitamin B12 and vitamin D. Serologic testing was positive for anti-transglutaminase IgA antibodies, and duodenal biopsies confirmed celiac disease (CD) (Marsh stage 3a), along with Helicobacter pylori gastritis. Management consisted of a strict gluten-free diet, vitamin supplementation, and H. pylori eradication therapy. Over the following year, the patient demonstrated marked clinical improvement, with normalization of hematologic parameters, nutritional status, and growth. This case highlights the importance of considering CD in the differential diagnosis of unexplained pancytopenia in pediatric patients, even in the absence of overt gastrointestinal symptoms.