Osteomalacia revealing coeliac disease and primary biliary cirrhosis-related Fanconi syndrome in a patient with systemic sclerosis

B Terrier, F Fakhouri, A Berezne, M.-A Bouldouyre, P Guilpain, P Sogni, B Terris, L.-H Noël, L Guillevin, L Mouthon, Benjamin Terrier, Fadi Fakhouri (+5 others)
Systemic sclerosis (SSc) may affect the gastrointestinal tract and cause very rarely malabsorption syndrome related to bacterial overgrowth. Malabsorption syndrome may be responsible for weight loss, diarrhea, osteomalacia, and iron and vitamins defi ciency. We report the case of a SSc patient who developed osteomalacia caused by the combination of two exceptional conditions in the setting of SSc: coeliac disease (CD) and primary biliary cirrhosis (PBC)-related Fanconi syndrome. Oral prednisone
more » ... me. Oral prednisone with angiotensin-converting enzyme inhibitors, was initiated because of active lesions of tubulitis, and led to the complete regression of bone pains, and by the improvement of renal function and regression of the features of proximal tubulopathy. Thus, in the presence of vitamin defi ciencies in a patient with SSc, together with a search for malabsorption syndrome secondary to bacterial overgrowth, CD and/or PBC-associated Fanconi syndrome should be investigated.