A 33-year-old woman spent a month with fevers reaching 39 degrees Celsius, about 102 degrees Fahrenheit, along with muscle aches. She had no abdominal pain, no diarrhea and no weight loss. After doctors ruled out infection, cancer, and other likely causes, the answer turned up in her small intestine: celiac disease.
The case, published in October 2026 in Oxford Medical Case Reports, describes celiac disease disguised as a fever of unknown origin. The authors, physicians in Marrakesh, Guelmim and Agadir in Morocco, titled their report «Pyrexia as the primary paradox.»
A Fever with No Obvious Source
The woman had no significant medical history and reported no recent travel, sick contacts or new medications. On examination, she was pale and thin, with a racing heart rate of 130 beats per minute and low blood pressure of 95/55 mm Hg.
Her blood work held two important clues. She had severe iron deficiency anemia, with hemoglobin of 8.0 g/dL and a ferritin level of 7 ng/mL, a sign of depleted iron stores. Her C-reactive protein, a marker of inflammation, was markedly elevated at 140 mg/L. Doctors found no swollen lymph nodes, no enlarged liver or spleen, and no neurological problems.
Doctors then worked through the usual suspects for a prolonged fever. Blood cultures and urine studies were negative, as were tests for HIV, hepatitis B, hepatitis C and tuberculosis. An echocardiogram showed no sign of heart valve infection. Antinuclear antibody and antineutrophil cytoplasmic antibody tests were negative. Muscle enzyme levels were normal, electromyography showed no muscle disease, a blood protein analysis was unremarkable, and CT scans of the chest, abdomen and pelvis showed no tumor or abscess.
An Antibody Test Points to the Gut
The turning point was a blood test for celiac disease. Her anti-tissue transglutaminase IgA antibody level, a widely used screening marker for the condition, was 37 U/mL, far above the laboratory’s normal cutoff of less than 4.
An upper endoscopy showed flattened folds in the duodenum, the first part of the small intestine. A biopsy confirmed partial loss of the finger-like villi that absorb nutrients, along with increased immune cells in the intestinal lining, findings consistent with celiac disease at modified Marsh stage IIIa.
Celiac disease is an autoimmune disorder in which eating gluten, a protein found in wheat, barley and rye, triggers the immune system to damage the small intestine. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), about 1% of people worldwide have the condition, including about 2 million people in the United States.
A damaged intestine can absorb iron poorly, which helps explain the woman’s anemia. Unexplained iron deficiency is a recognized reason to consider celiac testing.
A Gluten-Free Diet and a Falling Fever
Doctors treated her fever and aches with acetaminophen, gave intravenous iron and started a gluten-free diet. When she left the hospital on day 10, she was fever-free and her CRP had fallen to 75 mg/L.
At a three-month follow-up, her fevers and other whole-body symptoms had resolved and she had gained weight. Her hemoglobin had risen to 10.2 g/dL, and her CRP had returned to normal at 5 mg/L. She continued the gluten-free diet and oral iron.
The improvement after removing gluten supports the diagnosis, though a single case cannot prove that celiac disease alone explains every symptom. The authors proposed a possible mechanism: inflammation triggered by gluten releases immune signaling molecules such as interleukin-6 and tumor necrosis factor alpha, which can raise the brain’s temperature set point. That idea is drawn from earlier research. Cytokine levels were not measured in this patient, so the mechanism remains a hypothesis.
Rare, Not Unprecedented, and Easy to Miss
Fever is not a typical feature of celiac disease. The authors described it as an exceptionally rare presentation documented only in isolated case reports, and the case is not the first. A 2013 case report described a 16-year-old girl whose celiac disease also surfaced as a fever of unknown origin.
Fever of unknown origin is a classic diagnostic challenge: a prolonged fever that remains unexplained after a thorough initial evaluation. Infections, cancers and inflammatory diseases account for many cases, and digestive disorders are rarely the first thing doctors consider when the gut seems quiet.
The authors argue that clinicians should consider celiac testing in adults with prolonged, unexplained fever, particularly when iron deficiency anemia is present. The blood test is inexpensive and widely available.
Celiac disease can show up far from the gut in other ways too. NIDDK lists symptoms beyond digestion, including fatigue, joint or bone pain, and an itchy, blistering skin rash called dermatitis herpetiformis.
For readers, one practical point applies. NIDDK notes that doctors don’t recommend going gluten-free before testing, because cutting gluten first can make the diagnosis harder to confirm. Anyone who suspects celiac disease should talk with a clinician before changing their diet.
Key Questions Answered
What happened in this case?
A 33-year-old woman in Morocco had a month of fevers and muscle aches without digestive symptoms. After extensive testing, she was diagnosed with celiac disease.
How did doctors find the celiac disease?
A blood test showed high anti-tissue transglutaminase IgA antibodies, and a biopsy of the small intestine confirmed the diagnosis.
Can celiac disease cause fever?
It is unusual, but it has been reported. The authors suggest that gluten-triggered inflammation may raise body temperature, though this mechanism has not been proven.
How was the woman treated?
She received intravenous iron and started a gluten-free diet. Her fever resolved, and her inflammation marker returned to normal within three months.
Should someone stop eating gluten before testing?
No. Testing works best while gluten is still in the diet, so people should speak with a clinician before making changes.
Published by Medicaldaily.com
