A case of multiple sclerosis with atypical onset associated with autoimmune hepatitis and silent coeliac disease

Multiple sclerosis (MS) and coeliac disease (CD) are an uncommon association. Recently "MS-like illness and CNS white-matter abnormalities" have been demonstrated in patients with CD. We report the case of a 19-year-old female with MS, who presented an episode of headache at onset of disease and developed acute hepatitis (AH) 14 months later. After the diagnosis of AH, an occult CD, confirmed by jejunal biopsy, was disclosed. Constipation was the only gastrointestinal symptom. A serum sample collected before onset of MS was positive for CD. Anti-central nervous system antibodies were negative in both retrospective and current serum samples. Conclusions The concomitant presence of MS with atypical onset, AH and CD likely represents an unusual chance association in our patient but inflammatory immune-mediated damage of the central nervous system triggered by gluten could not be excluded.