Abstract

Introduction and Importance: The simultaneous presentation of inflammatory bowel disease (IBD) and celiac disease (CeD) in early childhood is exceedingly rare, especially when rectal prolapse is a leading symptom. This case report presents a 2-year-old male patient with both conditions, highlighting the diagnostic and therapeutic complexities in low-resource settings.

Case Presentation: A 2-year-old Syrian boy was evaluated for chronic diarrhea spanning 18 months, significant failure to thrive, and recurrent rectal prolapse over the past 6 months. Laboratory findings showed anemia and elevated anti-DGP IgA levels, raising suspicion for CeD. Duodenal biopsy confirmed Marsh 3b celiac disease, and colonoscopy with biopsy revealed IBD-unclassified. Despite initiation of a gluten-free diet, symptoms persisted, prompting further evaluation and a revised management strategy.

Clinical Discussion: The co-existence of CeD and IBD presents diagnostic challenges, as one condition can mask or mimic the other. This child’s persistent symptoms despite dietary modifications warranted re-examination of the initial diagnosis. Due to financial limitations, genetic testing for monogenic IBD was not feasible. A conservative treatment approach combining a gluten-free diet and high-fiber intake was adopted. The patient showed gradual improvement, underscoring the role of non-pharmacological strategies in carefully selected cases.

Conclusions: This case underscores the need for heightened clinical suspicion of immune-mediated gastrointestinal overlap syndromes in children presenting with unusual symptoms. It advocates for early multidisciplinary intervention and supports the use of dual dietary management in similar complex pediatric cases, especially in resource-constrained environments.