Hemoptoë als symptoom van coeliakie

Background

Most patients with coeliac disease have atypical gastro-intestinal symptoms or extra-intestinal symptoms only. It is difficult to recognise in these cases.

Case description

A 43-year-old man complained of haemoptysis, dyspnoea, and night sweats, but not of gastro-intestinal symptoms. He had an iron-deficiency anaemia (Hb: 4.1 mmol/l) and bilateral ground-glass opacities on a thorax CT. Bronchoscopy with broncho-alveolar lavage revealed no abnormalities, except haemosiderophages, consistent with alveolar bleeding. Testing for infectious and auto-immune diseases revealed no abnormalities, except an elevated level of anti-tissue transglutaminase antibodies. Duodenal biopsies revealed complete villous atrophy. With a gluten-free diet, the symptoms and ground-glass opacities disappeared in four months.

Conclusion

The triad of haemoptysis, alveolar bleeding, and iron-deficiency anaemia secondary to coeliac disease is known as the Lane-Hamilton syndrome. Coeliac disease is considered a heterogeneous systemic disease that can manifest itself as varying symptoms, including this rare syndrome. Signs of malabsorption such as iron deficiency, comorbid auto-immune disease, and a family history point towards coeliac disease.

Conflict of interest: none declared. Financial support: none declared.