DOI: https://doi.org/10.36347/sjmcr.2026.v14i05.052

Pages: 1088-1090

Celiac disease (CD) is a chronic immune-mediated disorder triggered by gluten ingestion in genetically predisposed individuals, increasingly recognized for its diverse extra-intestinal manifestations. We report a rare case of a 32-year-old woman presenting with prolonged fever of unknown origin as the sole manifestation of CD. The patient experienced recurrent high-grade fevers associated with fatigue over several months, without gastrointestinal symptoms. Initial investigations revealed iron-deficiency anemia and elevated inflammatory markers, while infectious, neoplastic, and autoimmune workups were unremarkable. Further evaluation demonstrated markedly elevated tissue transglutaminase IgA levels. Upper gastrointestinal endoscopy showed characteristic duodenal mucosal changes, and histopathology confirmed villous atrophy with intraepithelial lymphocytosis (Marsh 3a), establishing the diagnosis of CD. Initiation of a strict gluten-free diet resulted in rapid resolution of symptoms and normalization of serological markers within six months. This case highlights CD as a potential and rare cause of fever of unknown origin, emphasizing its status as a clinical chameleon with atypical presentations. Incorporating CD screening into the diagnostic approach for unexplained fever may facilitate early diagnosis and prevent long-term complications.