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Feeding difficulties such as dysphagia, slow feeding and hyperextension of head while eating may present later in life since liquid diets are tolerated earlier and symptoms typically manifest when solid foods are initiated.
The first one, known as the hygiene hypothesis postulates that a more sanitary childhood environment should prevent the host from developing tolerance to organisms that may present later in life, with the subsequent development of CD lesions [41].
Patients without systemic involvement may present later in the course of their disease.
It is possible that some of these cases may present later in infancy, which could explain part of the difference.
Infrequently, patients may present later in life with a dystonic tremor or akinetic-rigid parkinsonism (Tassin et al., 2000; Trender-Gerhard et al., 2009).
Whilst some adults may present later on in life with serious mental health problems [ 9] it is likely that many continue to suffer alone without healthcare.
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They may also present later as intrahepatic duct calculi due to recurrent biliary invasion [5].
Patients with a history of recent heavy alcohol consumption may also present later in the disease course for a variety of reasons.
Unique among atypical AD variants, temporal variant AD is a late-onset AD syndrome, and may present even later than typical AD.
By contrast, in Type 1 diabetes absolute insulin deficiency is usual outside the initial 'honeymoon period', the period soon after diagnosis when some residual β‐cell function may persist 5. Some patients may present clinically later in life as having Type 2 diabetes, but have the autoimmune destructive process as seen in Type 1 diabetes.
In addition, intraoperative fractures may have passed unnoticed to present later as a femoral shaft fracture [ 29].
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