Cutaneous Hyperpigmentation

A Rare Extra-Intestinal Manifestation of Celiac Disease

Abstract

Celiac disease has many manifestations. In paediatric population, it is usually presented as malabsorption with
chronic diarrhea and poor growth. This female child of 3.5 year old from Shabwa governorate was presented to us
with anemia required frequent blood transfusions and black discoloration of skin particularly of hands and feet. There
was no gastrointestinal symptoms. Her growth parameters and rest of clinical picture was normal apart from paleness
and skin black discoloration. Her initial investigations showed low Hb, normal WBC and Plat count, blood film
showed leukoerthoblastic picture with increased number of atypical lymphocyte, and Bone Marrow Aspiration was
inconclusive, but no blast cells. No definite diagnosis was made. Because of the long standing suffering, the family
decided to take her abroad (Egypt). She was investigated there and found to have megaloblastic anemia secondary to
celiac disease. She was put on vitamin B12 injection, folic acid and gluten free diet. Her condition was dramatically
improved and when we saw her few weeks later in Mukalla she was complete normal with normalization of her CBC
and disappearance of the skin discoloration.