Severe Acute ulcerative Colitis Disease with Severe Celiac Disease Associated with Clostridium difficile Colitis Infection Complicated with Refeeding Syndrome, Challenging Case Report

Abstract

Crohn's disease, ulcerative colitis, and celiac disease are disorders mediated by the immune system. The coincidence of celiac disease with inflammatory bowel disease is an infrequent occurrence, particularly in pediatric populations, though it is acknowledged in adult cases. This paper presents a unique case involving a 24-year-old male patient who experienced persistent vomiting, significant weight loss, and bloody diarrhea accompanied by abdominal pain and urgency. During his medical evaluation, we detected the presence of celiac antibodies, elevated inflammatory markers, and anemia. Endoscopic examination revealed pancolitis, pseudomembranous colitis, and atrophy of the duodenal villi. The patient concurrently had celiac disease, ulcerative colitis, Clostridium difficile colitis, and active Helicobacter pylori-associated chronic gastritis. Clostridium difficile colitis is a serious yet common complication in patients with IBD, necessitating simultaneous management of both disorders. His dual autoimmune conditions deteriorated, necessitating immunosuppressive therapy. However, the initiation of immunosuppression led to refeeding syndrome, adding complexity to the management of his condition.