Celiac crisis as an initial presentation of adult celiac disease: A case report and brief literature review

Celiac crisis is a rare, life-threatening manifestation of celiac disease characterized by acute, profuse diarrhea, severe dehydration, and profound metabolic disturbances. Although traditionally considered a pediatric complication, it is increasingly recognized in adults, often heralding the onset of the disease. We present the case of a 32-year-old previously healthy female who developed a celiac crisis. Extensive evaluations, including serology and duodenal biopsy, confirmed the diagnosis of celiac disease with marked villous atrophy, while effectively excluding enteropathy-associated T-cell lymphoma (EATL). The patient required intensive resuscitation, parenteral nutrition, and a short course of systemic corticosteroids alongside a strict gluten-free diet to achieve clinical and metabolic stabilization. 
This case underscores the critical importance of considering celiac crisis in the differential diagnosis of severe acute malabsorptive syndromes in adults. Early recognition and prompt initiation of dietary and supportive therapies are paramount to prevent serious complications, such as refeeding syndrome or cardiovascular collapse. Furthermore, the successful integration of corticosteroids underscores their utility in refractory or critically ill presentations when dietary withdrawal alone is insufficient to reverse mucosal inflammation rapidly.