Polyneuropathy in Association With Coeliac Disease

Abstract

Gluten sensitive enteropathy is a bowel disease causing malabsorption. In geneticallysusceptible people, the gluten in wheat arouses a humaral and cell-mediated immune reaction. Various central and peripheral neurological syndromes are seen in association with gluten enteropathy and malabsorption, autoimmune mechanisms or the toxic effect of gluten itself are thought to be the possible causative factors . Gluten enteropathy has only lately and rarely been diagnosed in cases with neurological syndromes of unknown aetiology. A 39 year-old female patient complaining of mild weakness in both hands for two month, became bedridden within five days due to rapidly progressing, ascending tetraparesis. She was complaining of glove-stocking paresthesias too. She had previous intestinal diarrhea attacks and dyspepsia for almost 20 years. Physical examinationrevealed cachectia, pale skin, finger clubbing, abdominal distention and hypertimpanism. Neurological examination showed sensorimotor polyneuropathy and EMG exhibited a sensorimotor, axonal peripheral neuropathy involving predominantly motor nerves, one prolonged F response latency and one conduction block with distally predominantneuropathic changes. Albuminocytological dissociation in the CSF, anemia, trombocytosis, high sedimentation rate and folate deficiency were associated laboratory findings. lntestinal followthrough examination with contrast material showed changes attributable to malabsorption and endoscopic intestinal biopsy was compatible withgluten enteropathy. Antigliadin antibodies were positive. Paranodal segmental demyelination were identified in peripheral nerve biopsy. We hereby present this patient in order to emphasize that gluten enteropathy, though quite rarely, may be associated with an acute, treatable peripheral neuropathy.