Celiac Disease in Patients with Type 1 Diabetes and Negative Serology: About Two Cases and Literature Review

Abstract Introduction: Celiac disease (CD) is an autoimmune enteropathy triggered by gluten ingestion in genetically predisposed individuals. It is frequently associated with type 1 diabetes (T1D), with a prevalence significantly higher than that observed in the general population. Diagnosis usually relies on positivity of specific autoantibodies and histological confirmation. However, seronegative forms can be observed, notably in T1D patients, making diagnosis more complex. Observation: We report two cases of type 1 diabetic patients in whom the diagnosis of celiac disease was confirmed based on histological arguments despite negative serology. Discussion: The negativity of specific CD antibodies does not exclude the diagnosis, particularly in T1D patients presenting suggestive signs such as anemia, unexplained glycemic disorders, or signs of malabsorption. Duodenojejunal biopsy remains the reference examination in these situations. Conclusion: In patients with T1D, celiac disease can evolve silently or atypically, with negative serology. Increased clinical vigilance and early use of digestive histology are essential to prevent metabolic and nutritional complications.