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We report an unusual case of 39-year-old male twins, one presenting with iron deficiency anaemia and the other asymptomatic, with anti-tTG antibodies of &gt;4,965.5\u2009U\/ml, an extraordinary level. A duodenal biopsy confirmed a diagnosis of CD and following the adoption of a gluten-free diet, anti-tTG levels were found to decrease back to normal levels. This case demonstrates how CD can cause significant biochemical and histological pathology, but present with mild or no symptoms.<\/jats:p>","DOI":"10.1177\/14782715221088971","type":"journal-article","created":{"date-parts":[[2022,6,16]],"date-time":"2022-06-16T10:09:15Z","timestamp":1655374155000},"page":"39-41","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Unusually high titres of anti-tissue transglutaminase antibodies in monozygotic twins"],"prefix":"10.1177","volume":"52","author":[{"given":"Harriet","family":"Lomas","sequence":"first","affiliation":[{"name":"Cardiff University, Cardiff, Wales, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"India","family":"Rees","sequence":"additional","affiliation":[{"name":"Nevill Hall Hospital, Abergavenny, Wales, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nadim","family":"Haboubi","sequence":"additional","affiliation":[{"name":"Nevill Hall Hospital, Abergavenny, Wales, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2022,6,9]]},"reference":[{"key":"bibr1-14782715221088971","first-page":"38","volume":"62","author":"Rashid M","year":"2016","journal-title":"Can Fam Physician"},{"key":"bibr2-14782715221088971","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-019-1380-z"},{"key":"bibr3-14782715221088971","doi-asserted-by":"publisher","DOI":"10.1016\/0016-5085(92)91819-P"},{"key":"bibr4-14782715221088971","doi-asserted-by":"publisher","DOI":"10.4291\/wjgp.v8.i2.27"},{"key":"bibr5-14782715221088971","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpg.2005.01.001"},{"key":"bibr6-14782715221088971","volume":"33","author":"Battacharya M","year":"2014","journal-title":"Indian J Gastroenterol"},{"key":"bibr7-14782715221088971","doi-asserted-by":"publisher","DOI":"10.1155\/2016\/6718590"},{"key":"bibr8-14782715221088971","doi-asserted-by":"publisher","DOI":"10.15171\/mejdd.2016.42"},{"key":"bibr9-14782715221088971","volume":"28","author":"Mubarak A","year":"2012","journal-title":"World J Gastroenterol"},{"key":"bibr10-14782715221088971","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0b013e31821a23d0"},{"key":"bibr11-14782715221088971","doi-asserted-by":"publisher","DOI":"10.1136\/adc.54.5.395"},{"key":"bibr12-14782715221088971","doi-asserted-by":"publisher","DOI":"10.1136\/jmg.12.1.79"},{"key":"bibr13-14782715221088971","doi-asserted-by":"publisher","DOI":"10.1016\/j.molmed.2010.09.003"},{"key":"bibr14-14782715221088971","doi-asserted-by":"publisher","DOI":"10.1136\/gut.50.5.624"},{"key":"bibr15-14782715221088971","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/3049286"},{"key":"bibr16-14782715221088971","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000008562"},{"key":"bibr17-14782715221088971","doi-asserted-by":"publisher","DOI":"10.1177\/2050640618765506"},{"key":"bibr18-14782715221088971","doi-asserted-by":"publisher","DOI":"10.1038\/s41574-019-0311-6"},{"key":"bibr19-14782715221088971","doi-asserted-by":"publisher","DOI":"10.1080\/00365521.2016.1203017"},{"key":"bibr20-14782715221088971","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2003.032094"},{"key":"bibr21-14782715221088971","doi-asserted-by":"publisher","DOI":"10.1016\/S8756-3282(98)00178-1"},{"key":"bibr22-14782715221088971","doi-asserted-by":"publisher","DOI":"10.3109\/00365528209181045"}],"container-title":["Journal of the Royal College of Physicians of Edinburgh"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/14782715221088971","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/14782715221088971","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/14782715221088971","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T05:55:17Z","timestamp":1777701317000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/14782715221088971"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3]]},"references-count":22,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,3]]}},"alternative-id":["10.1177\/14782715221088971"],"URL":"https:\/\/doi.org\/10.1177\/14782715221088971","relation":{},"ISSN":["1478-2715","2042-8189"],"issn-type":[{"value":"1478-2715","type":"print"},{"value":"2042-8189","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3]]}}}