[Hypochromic microcytic anemia as the only manifestation of celiac disease].

Background: Extraintestinal symptoms and signs may be the only manifestations of celiac sprue.
Methods: We report a case of a patient with hypochromic microcytic anemia as the only expression of the disease.
Results: Was asymptomatic the patient with pallor at physical examination. The laboratory showed only hypochromic microcytic anemia due to iron deficiency. She was previously was treated twice with oral iron without achieving good results. The upper gastrointestinal endoscopy, the colonoscopy, and the small bowel barium contrast study were normal. The small bowel biopsy showed villous atrophy and a chronic inflammatory infiltrate of the lamina propria. The antiendomysial and antireticulin antibodies were negative. The IgA antigliadin antibody was positive (1:120). The patient was initiated on a gluten free diet and oral iron. After four months of treatment, hemoglobin and the iron serum levels were normal and at 6 months, the small bowel biopsy showed striking improvement.
Conclusions: Familiarity with the diverse extraintestinal features of celiac sprue and a high index of suspicion are essential for accurate diagnosis in patients with subtle presentations.