Celiac disease presenting with peripheral neuropathy in children: A case report

Alessandra Pacitto, Alessandra Paglino, Lorenza Di Genova, Alberto Leonardi, Edoardo Farinelli, Nicola Principi, Giuseppe di Cara, Susanna Esposito

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Clinically relevant neurological manifestations in children with celiac disease (CD) are unusual, especially when they are considered as signs of the onset of the disease. In this paper, a case of Guillain-Barrè syndrome (GBS) as the first manifestation of CD in a 23-month-old child is reported. Case presentation: We describe a case of CD onset with peripheral neuropathy in a 23-month-old Bulgarian boy presenting with a sudden refusal to walk and absence of deep tendon reflexes in both lower limbs. Neurological symptoms were preceded by two months of gastrointestinal symptoms such as vomiting, abdominal distention, and clear signs of malnutrition and weight loss. When we evaluated the child six months after the onset of the symptoms, clinical and laboratory findings showed clear signs of peripheral neuropathy associated with malnutrition. Serum deamidated gliadin and tissue transglutaminase antibodies were therefore measured. The anti-gliadin levels were more than sixteen times higher than normal and the IgA anti-transglutaminase levels were four times higher than normal. Anti-endomysium antibodies were positive, and human leukocyte antigens (HLA) II typing confirmed a genetic predisposition to CD (DQ2 positive and DQ8 negative). Given the association between the clinical evidence of the disease and the results of the celiac screening tests, a diagnosis of CD was made without biopsy confirmation of the enteropathy. The child began a restricted gluten-free diet that led to complete recovery of the peripheral neuropathy, walking, reflexes, and overall improvement after three months on the diet. Conclusion: Our case underlines the rare but possible associations between CD and peripheral neuropathy in children as an onset symptom, even in the absence of gastrointestinal manifestations, thus suggesting that CD should always be considered in the differential diagnosis of peripheral neuropathy in children. A good knowledge of the extra-intestinal manifestations of CD is essential for the rapid introduction of a gluten-free diet that could be useful for the resolution of the neurological symptoms.

Original languageEnglish
Article number785
JournalInternational Journal of Environmental Research and Public Health
Volume14
Issue number7
DOIs
Publication statusPublished - Jul 14 2017

Fingerprint

Celiac Disease
Peripheral Nervous System Diseases
Gliadin
Gluten-Free Diet
Malnutrition
Stretch Reflex
Transglutaminases
Genetic Predisposition to Disease
HLA Antigens
Neurologic Manifestations
Walking
Vomiting
Reflex
Weight Loss
Anti-Idiotypic Antibodies
Lower Extremity
Differential Diagnosis
Diet
Biopsy
Antibodies

Keywords

  • Atypical celiac disease
  • Celiac disease
  • Gluten-free diet
  • Guillain-Barrè syndrome
  • Peripheral neuropathy

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Health, Toxicology and Mutagenesis

Cite this

Pacitto, A., Paglino, A., Di Genova, L., Leonardi, A., Farinelli, E., Principi, N., ... Esposito, S. (2017). Celiac disease presenting with peripheral neuropathy in children: A case report. International Journal of Environmental Research and Public Health, 14(7), [785]. https://doi.org/10.3390/ijerph14070785

Celiac disease presenting with peripheral neuropathy in children : A case report. / Pacitto, Alessandra; Paglino, Alessandra; Di Genova, Lorenza; Leonardi, Alberto; Farinelli, Edoardo; Principi, Nicola; di Cara, Giuseppe; Esposito, Susanna.

In: International Journal of Environmental Research and Public Health, Vol. 14, No. 7, 785, 14.07.2017.

Research output: Contribution to journalArticle

Pacitto, A, Paglino, A, Di Genova, L, Leonardi, A, Farinelli, E, Principi, N, di Cara, G & Esposito, S 2017, 'Celiac disease presenting with peripheral neuropathy in children: A case report', International Journal of Environmental Research and Public Health, vol. 14, no. 7, 785. https://doi.org/10.3390/ijerph14070785
Pacitto, Alessandra ; Paglino, Alessandra ; Di Genova, Lorenza ; Leonardi, Alberto ; Farinelli, Edoardo ; Principi, Nicola ; di Cara, Giuseppe ; Esposito, Susanna. / Celiac disease presenting with peripheral neuropathy in children : A case report. In: International Journal of Environmental Research and Public Health. 2017 ; Vol. 14, No. 7.
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abstract = "Background: Clinically relevant neurological manifestations in children with celiac disease (CD) are unusual, especially when they are considered as signs of the onset of the disease. In this paper, a case of Guillain-Barr{\`e} syndrome (GBS) as the first manifestation of CD in a 23-month-old child is reported. Case presentation: We describe a case of CD onset with peripheral neuropathy in a 23-month-old Bulgarian boy presenting with a sudden refusal to walk and absence of deep tendon reflexes in both lower limbs. Neurological symptoms were preceded by two months of gastrointestinal symptoms such as vomiting, abdominal distention, and clear signs of malnutrition and weight loss. When we evaluated the child six months after the onset of the symptoms, clinical and laboratory findings showed clear signs of peripheral neuropathy associated with malnutrition. Serum deamidated gliadin and tissue transglutaminase antibodies were therefore measured. The anti-gliadin levels were more than sixteen times higher than normal and the IgA anti-transglutaminase levels were four times higher than normal. Anti-endomysium antibodies were positive, and human leukocyte antigens (HLA) II typing confirmed a genetic predisposition to CD (DQ2 positive and DQ8 negative). Given the association between the clinical evidence of the disease and the results of the celiac screening tests, a diagnosis of CD was made without biopsy confirmation of the enteropathy. The child began a restricted gluten-free diet that led to complete recovery of the peripheral neuropathy, walking, reflexes, and overall improvement after three months on the diet. Conclusion: Our case underlines the rare but possible associations between CD and peripheral neuropathy in children as an onset symptom, even in the absence of gastrointestinal manifestations, thus suggesting that CD should always be considered in the differential diagnosis of peripheral neuropathy in children. A good knowledge of the extra-intestinal manifestations of CD is essential for the rapid introduction of a gluten-free diet that could be useful for the resolution of the neurological symptoms.",
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