Isotretinoin-associated Celiac Disease

27-yr old female marathon runner presented with profound fatigue and reduced exercise tolerance due to an iron deficiency anemia subsequent to treatment with isoretinoin for acne. Subsequent histologic and serologic studies revealed small bowel biopsies with histopathological features of celiac disease and an increased IgA tissue transglutaminase level. Isoretinoin use was terminated and after treatment with a gluten-free diet and oral iron, her symptoms resolved with normalization of her serological studies. Now, she remains completely well on a gluten-free diet alone and recently completed a full marathon.