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Celiac disease with cerebral and peripheral nerve involvement mimicking multiple sclerosis.

Finsterer J, Leutmezer F - J Med Life (2014)

Bottom Line: Due to the similarity in the clinical presentation, morphology, and course, celiac disease (CD) may be mixed up with other immunological disorders, such as multiple sclerosis (MS).In a 43-year-old Caucasian male with a history of diarrhea and colics since young age, progressive sensory disturbances developed since age 18 years.At age 34, he was diagnosed as relapsing-remitting MS upon an inflammatory CSF-syndrome and non-specific white matter lesions and treated with interferon beta-1b during the next 8 years without effect.

View Article: PubMed Central - PubMed

Affiliation: Krankenanstalt Rudolfstiftung, Vienna, Austria.

ABSTRACT

Objectives: Due to the similarity in the clinical presentation, morphology, and course, celiac disease (CD) may be mixed up with other immunological disorders, such as multiple sclerosis (MS).

Case report: In a 43-year-old Caucasian male with a history of diarrhea and colics since young age, progressive sensory disturbances developed since age 18 years. At age 34, he was diagnosed as relapsing-remitting MS upon an inflammatory CSF-syndrome and non-specific white matter lesions and treated with interferon beta-1b during the next 8 years without effect. At age 35, axonal polyneuropathy and ataxia were diagnosed. Despite normal anti-gliadin, endomysial, and transglutaminase antibodies, CD was diagnosed at age 41, based upon the history, polyneuropathy, positivity for HLA-DQ2 and HLA-DQ8, the white matter lesions, and a beneficial response of the gastrointestinal problems and polyneuropathy to gluten-free diet.

Conclusions: CD may mimic MS and may be present despite the absence of anti-gliadin, endomysial or transglutaminase antibodies. CD should be considered if there is a gastrointestinal problem, polyneuropathy, and ataxia, even if CSF and MRI findings are suggestive of MS.

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Related in: MedlinePlus

Nerve conduction studies between 2002 and 2012
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Figure 2: Nerve conduction studies between 2002 and 2012

Mentions: At a follow-up in 4/2012, he admitted to have drunk alcohol excessively between 1985 and 1995 and to be impotent for some time. Neurological exam revealed gaze-evoked nystagmus, brady diadochokinesis, intention ataxia on the left side, stocking type hypoesthesia on the lower limbs, absent tendon reflexes on the lower limbs, and ataxic stance and gait, this is why he used two crutches for walking. Standing without support resulted in a tendency to fall. Blood tests revealed elevated myoglobin, vitamin-B12 deficiency, and vitamin-D-deficiency, but no gliadin (endomysial) and transglutaminase autoantibodies were found (Table 2). Nerve conduction studies revealed a slight improvement compared to previous investigations, such that the sural nerve could be stimulated again and that nerve conduction velocity of the right peroneal nerve improved (Table 3).


Celiac disease with cerebral and peripheral nerve involvement mimicking multiple sclerosis.

Finsterer J, Leutmezer F - J Med Life (2014)

Nerve conduction studies between 2002 and 2012
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4233456&req=5

Figure 2: Nerve conduction studies between 2002 and 2012
Mentions: At a follow-up in 4/2012, he admitted to have drunk alcohol excessively between 1985 and 1995 and to be impotent for some time. Neurological exam revealed gaze-evoked nystagmus, brady diadochokinesis, intention ataxia on the left side, stocking type hypoesthesia on the lower limbs, absent tendon reflexes on the lower limbs, and ataxic stance and gait, this is why he used two crutches for walking. Standing without support resulted in a tendency to fall. Blood tests revealed elevated myoglobin, vitamin-B12 deficiency, and vitamin-D-deficiency, but no gliadin (endomysial) and transglutaminase autoantibodies were found (Table 2). Nerve conduction studies revealed a slight improvement compared to previous investigations, such that the sural nerve could be stimulated again and that nerve conduction velocity of the right peroneal nerve improved (Table 3).

Bottom Line: Due to the similarity in the clinical presentation, morphology, and course, celiac disease (CD) may be mixed up with other immunological disorders, such as multiple sclerosis (MS).In a 43-year-old Caucasian male with a history of diarrhea and colics since young age, progressive sensory disturbances developed since age 18 years.At age 34, he was diagnosed as relapsing-remitting MS upon an inflammatory CSF-syndrome and non-specific white matter lesions and treated with interferon beta-1b during the next 8 years without effect.

View Article: PubMed Central - PubMed

Affiliation: Krankenanstalt Rudolfstiftung, Vienna, Austria.

ABSTRACT

Objectives: Due to the similarity in the clinical presentation, morphology, and course, celiac disease (CD) may be mixed up with other immunological disorders, such as multiple sclerosis (MS).

Case report: In a 43-year-old Caucasian male with a history of diarrhea and colics since young age, progressive sensory disturbances developed since age 18 years. At age 34, he was diagnosed as relapsing-remitting MS upon an inflammatory CSF-syndrome and non-specific white matter lesions and treated with interferon beta-1b during the next 8 years without effect. At age 35, axonal polyneuropathy and ataxia were diagnosed. Despite normal anti-gliadin, endomysial, and transglutaminase antibodies, CD was diagnosed at age 41, based upon the history, polyneuropathy, positivity for HLA-DQ2 and HLA-DQ8, the white matter lesions, and a beneficial response of the gastrointestinal problems and polyneuropathy to gluten-free diet.

Conclusions: CD may mimic MS and may be present despite the absence of anti-gliadin, endomysial or transglutaminase antibodies. CD should be considered if there is a gastrointestinal problem, polyneuropathy, and ataxia, even if CSF and MRI findings are suggestive of MS.

Show MeSH
Related in: MedlinePlus