There is a wide spectrum of presentations, varying from a clinically silent form to the classical

malabsorption syndrome.1 Although primarily affecting the small bowel, CD is a multisystem illness. The potential target organs include the liver, pancreas, heart, kidney, thyroid gland, bone, skin and nervous system, giving rise to a variety of extraintestinal manifestations.1 and 2 A number of hepatobiliary disorders have been documented in patients with CD. The most common pattern of liver damage is a gluten sensitive form of hepatitis (celiac hepatitis). The usual manifestation consists of PARP phosphorylation an isolated elevation of aminotransferases. In this context, liver biopsy check details is usually of limited value, since the histological findings are nonspecific and there is a complete response

to dietary treatment. 2 More rarely, CD is associated with a group of liver disorders sharing common genetic factors and immunopathogenesis, such as autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC). If this is the case, gluten withdrawal is usually insufficient to normalize liver tests and to prevent progressive liver damage and a specific management is required. 3 and 4 A 21-year-old woman was referred to evaluation because of an unclear elevation of liver enzymes. The patient was asymptomatic and routine laboratory tests made six months earlier incidentally detected a 1.5 to 2-fold elevation of both aspartate aminotransferase (AST) and alanine aminotransferase (ALT). She

denied any history of alcohol or illicit drugs use and she was not taking any medications, including nonprescription ones. There was no evidence of risk factors for viral hepatitis. Her past medical history was unremarkable and no family history of liver or gastrointestinal disorders could be identified. The physical examination was normal, with a body mass index (BMI) of 19 kg/m2 and no signs of liver disease. The initial laboratory study evidenced AST 40 U/L (upper limit of reference, 31 U/L) and ALT 64 U/L (upper limit of reference, 34 U/L), with normal alkaline fosfatase, γ-glutamyl transferase, bilirubin and normal hemogram. Abdominal ultrasound examination was normal. A complete screen selleck chemicals for the possible etiology of abnormal liver tests was performed. Serologic markers for viral hepatitis were negative. Transferrin saturation, ferritin, ceruloplasmin, α1-antitrypsin and thyroid function tests were normal. The serum protein electrophoresis and immunoglobulin study disclosed an elevation of serum immunoglobulin (Ig) G concentrations (19.7 g/L; normal 7–16 g/L) and low serum IgA (0.24 g/L; normal 0.7–4 g/L). The autoantibody profile was characterized by positive antinuclear (+++), anti-double-strand DNA (6.1 U/mL; normal < 4.