Background: Association of distal renal tubular acidosis (RTA) with autoimmune diseases is extremely rare in children.
Case characteristics: 12-year-old girl with distal RTA. Despite resolution of acidosis on bicarbonate, she continued to have poor growth and delayed puberty. Investigations revealed autoimmune thyroiditis and celiac disease.
Outcome: Levothyroxine and gluten-free diet were initiated. Child gained height and weight and had onset of puberty after gluten withdrawal.
Message: Distal RTA in children may rarely be of autoimmune etiology.