Micronutrient Deficiencies as Early Signs of Celiac Disease: Exemplified by Two Cases

Celiac disease is an important yet often overlooked condition that, when left untreated, can lead to intestinal villous atrophy, resulting in malabsorption and nutritional deficiencies. The clinical presentation of celiac disease varies greatly and is not limited to gastrointestinal symptoms. The diverse clinical picture and nonspecific manifestations can lead to difficulties in the diagnostic process and a delay in diagnosis. In this article, we discuss two cases in which the diagnosis was established-but very late. The first case presents a woman who experienced symptoms for more than 10 years and was initially suspected of having cancer before finally receiving the correct diagnosis of celiac disease. The second case describes a former general practitioner who, at the age of 55 years, underwent transglutaminase antibody testing for celiac disease and only then realized that he could feel differently. Both cases presented early signs of micronutrient deficiencies and/or weight loss, despite maintaining an adequate dietary energy intake. These cases illustrate the challenges with diagnostic delay.