Celiac Disease as Chylous Ascites in a Child

10 year old with no significant history either in the past or family presented with tense ascites, hypochromic microcytic anemia, thrombocytosis and milky fluid with TAG level of 350 mg/dl with a SAAG of >1.1. LFT, chest xray and ascitic fluid ADA were normal. USG abdomen showed fine echoes from peritoneal cavity and normal liver and portal /hepatic veins. endoscopy was done to look for lymphangiectasia but gross morphology of duodenum was suggestive of celiac disease. Normal IgA, high anti TTG, biopsy marsh IIIB and clinical response to gluten free diet confirmed the diagnosis of celiac disease