Celiac disease (CD) is an autoimmune condition triggered by ingesting gluten, a protein found in wheat, barley, and rye. The immune reaction damages the small intestine lining, causing malabsorption and systemic symptoms. While the underlying inflammation can cause generalized feelings of illness, a high fever is not a typical symptom of uncomplicated celiac disease. A true, sustained elevation in body temperature usually indicates a secondary issue or a different illness.
Understanding the Inflammatory Nature of Celiac Disease
Celiac disease is fundamentally an inflammatory process mediated by T-cells in the small intestine mucosa following gluten exposure. This immune response leads to villous atrophy, the flattening of the finger-like projections responsible for nutrient absorption. The ongoing inflammatory cascade involves the release of signaling proteins known as cytokines.
These pro-inflammatory cytokines are responsible for systemic symptoms like fatigue, malaise, and brain fog. Although chronic inflammation can cause a low-grade temperature elevation (a sub-febrile state), it rarely results in a high-grade fever above 101°F (38.3°C).
In rare instances, a fever may occur due to the immune system’s over-activation and cytokine release, not an infection. This fever is typically intermittent, not sustained, and is often accompanied by symptoms like weight loss or joint pain.
Secondary Conditions and Complications That Cause Fever
Celiac disease is associated with several secondary complications that can lead to significant temperature elevations. One primary risk is functional hyposplenism, which is impaired spleen function. The spleen filters blood and fights off infections, particularly those caused by encapsulated bacteria.
Untreated celiac disease can cause this splenic dysfunction, increasing susceptibility to serious bacterial infections like pneumococcal sepsis. These overwhelming infections cause a sudden, high fever and require immediate medical attention. The risk of pneumococcal infection is significantly higher in people with celiac disease compared to the general population.
Malabsorption from poorly managed celiac disease can also lead to severe nutritional deficiencies, weakening the overall immune system. This compromised state makes individuals more vulnerable to common viral and bacterial illnesses, such as influenza or gastroenteritis, which naturally present with fever.
Celiac disease is frequently associated with other autoimmune disorders that may present with fever spikes. Conditions like autoimmune hepatitis or systemic lupus erythematosus (Lupus) are more common in people with celiac disease and are known causes of intermittent or persistent fever. In these situations, the fever is a symptom of the co-occurring condition, not a direct manifestation of the intestinal damage.
Distinguishing Celiac-Related Fever from Other Illnesses
Differentiating a mild, low-grade temperature from a serious, infection-related fever is important for proper management. A low-grade temperature, often below 100.4°F (38°C), that accompanies malaise, fatigue, or joint pain may relate to ongoing systemic inflammation or accidental gluten exposure. This sub-febrile state typically resolves within a few days or with strict adherence to the gluten-free diet.
A high fever, defined as 101°F (38.3°C) or higher, especially if it persists for more than 48 hours, warrants immediate medical evaluation. Urgent symptoms include high fever accompanied by severe, localized abdominal pain, a new rash, or signs of confusion. These symptoms raise concern for a secondary infection or a flare-up of an associated autoimmune condition.
It is important to inform any treating physician about the celiac disease diagnosis when presenting with a fever. This helps the healthcare provider consider complications like hyposplenism, which require specific testing and treatment protocols, such as aggressive antibiotics. Individuals with known splenic dysfunction should ensure they are up-to-date on vaccinations against encapsulated bacteria, such as the pneumococcal vaccine.