Sero-negative celiac disease with dermatitis herpetiformes: a case report

INTRODUCTION: We report a case of sero-negative celiac disease in Pakistan. CASE PRESENTATION: A 20-year-old female presented with papulovesicular rash for 15 years, diarrhea for 8 years, spasms of hands and twitching of face for 4-5 months. She had mild anemia, low vitamin-D3 and serum calcium. On exclusion of other causes of malabsorption, anti-tissue transglutaminase antibodies (immunoglobulin-A & immunoglobulin-G), anti-endomysial antibodies, total immunoglobulin-A levels and skin biopsy were performed, which were normal. Intestinal biopsy revealed subtotal villous atrophy. Patient was prescribed gluten-free diet, to which she responded with alleviation of symptoms. CONCLUSION: Negative serology should not rule out celiac disease; intestinal biopsy should be performed if there is strong clinical suspicion.