UNLABELLED: Neurologic manifestations are present in a reasonable proportion of adult celiac patients and can be the first sign of gluten sensitivity. In children, the risk of neurological complications is lower, and gluten sensitivity with neurological presentation seems to be rare. We report a case of gluten sensitivity with severe neurological presentation in a 3-year-old girl. In the absence of gastrointestinal symptoms, the presence of white matter lesions in cerebral magnetic resonance imaging suggested an acute disseminated encephalomyelitis. Recurrence of neurologic symptoms and cerebral lesions over a long period of time made the authors consider an autoimmune/inflammatory systemic disease. IgA anti-transglutaminase (TG) 2 was elevated and duodenal biopsy confirmed the presence of enteropathy. A gluten-free diet led to complete resolution of neurological manifestations and arrest of white matter lesions progression. CONCLUSION: In children with unclear neurologic manifestations with probable autoimmune etiology, anti-TG2 autoantibody titers should be determined considering the possibility of gluten sensitivity. Gluten-free diet remains the only effective treatment reported to date and, therefore, should be recommended to all patients with gluten sensitivity despite the type of manifestations. More studies, focusing on neurological manifestations and its response to gluten-free diet, are needed.
UNLABELLED: Neurologic manifestations are present in a reasonable proportion of adult celiac patients and can be the first sign of gluten sensitivity. In children, the risk of neurological complications is lower, and gluten sensitivity with neurological presentation seems to be rare. We report a case of gluten sensitivity with severe neurological presentation in a 3-year-old girl. In the absence of gastrointestinal symptoms, the presence of white matter lesions in cerebral magnetic resonance imaging suggested an acute disseminated encephalomyelitis. Recurrence of neurologic symptoms and cerebral lesions over a long period of time made the authors consider an autoimmune/inflammatory systemic disease. IgA anti-transglutaminase (TG) 2 was elevated and duodenal biopsy confirmed the presence of enteropathy. A gluten-free diet led to complete resolution of neurological manifestations and arrest of white matter lesions progression. CONCLUSION: In children with unclear neurologic manifestations with probable autoimmune etiology, anti-TG2 autoantibody titers should be determined considering the possibility of gluten sensitivity. Gluten-free diet remains the only effective treatment reported to date and, therefore, should be recommended to all patients with gluten sensitivity despite the type of manifestations. More studies, focusing on neurological manifestations and its response to gluten-free diet, are needed.
Authors: Marios Hadjivassiliou; David S Sanders; Richard A Grünewald; Nicola Woodroofe; Sabrina Boscolo; Daniel Aeschlimann Journal: Lancet Neurol Date: 2010-03 Impact factor: 44.182
Authors: M Hadjivassiliou; R A Grünewald; R H Kandler; A K Chattopadhyay; J A Jarratt; D S Sanders; B Sharrack; S B Wharton; G A B Davies-Jones Journal: J Neurol Neurosurg Psychiatry Date: 2006-07-11 Impact factor: 10.154
Authors: M Hadjivassiliou; S Boscolo; G A B Davies-Jones; R A Grünewald; T Not; D S Sanders; J E Simpson; E Tongiorgi; C A Williamson; N M Woodroofe Journal: Neurology Date: 2002-04-23 Impact factor: 9.910
Authors: Alessandra Pacitto; Alessandra Paglino; Lorenza Di Genova; Alberto Leonardi; Edoardo Farinelli; Nicola Principi; Giuseppe di Cara; Susanna Esposito Journal: Int J Environ Res Public Health Date: 2017-07-14 Impact factor: 3.390