Condições extraintestinais associadas à doença celíaca em pediatria - série de casos

Abstract

Celiac disease (CD) is a systemic immune-mediated disorder triggered by gluten ingestion in genetically susceptible individuals, with broad clinical manifestations and potential impact on growth, nutritional status, and extraintestinal health. In recent decades, pediatric presentation has shifted from classical malabsorption to predominantly non-classical and extraintestinal forms, often associated with diagnostic delay. This study reports three pediatric cases followed in a tertiary pediatric gastroenterology center, whose initial manifestations were mainly extraintestinal: growth velocity deceleration, dermatitis herpetiformis associated with chronic diarrhea, and positive screening in a patient with type 1 diabetes mellitus without gastrointestinal symptoms. Despite clinical heterogeneity, all patients presented advanced duodenal enteropathy at diagnosis. The implementation of a gluten-free diet resulted in catch-up growth, remission of dermatological manifestations, and clinical improvement, highlighting the impact of early diagnosis. These cases illustrate, in clinical practice, the diagnostic delay in extraintestinal presentations of CD and reinforce the need for high clinical suspicion among pediatricians, as well as systematic screening in high-risk groups, as essential strategies to reduce complications and the systemic burden of the disease during childhood.