Abstract
Many cases of coeliac disease, a gastrointestinal autoimmune disorder caused by sensitivity to gluten, can remain in a subclinical stage or undiagnosed. In a significant proportion of cases (10–15%) gluten intolerance can be associated with central or peripheral nervous system and psychiatric disorders.A 38-year-old man was admitted as to our department an inpatient for worsening anxiety symptoms and behavioural alterations. After the addition of second generation antipsychotic to the therapeutic regimen, the patient presented neuromotor impairment with high fever, sopor, leukocytosis, raised rhabdomyolysis-related indicators. Neuroleptic malignant syndrome was strongly suspected. After worsening of his neuropsychiatric conditions, with the onset of a frontal cognitive deficit, bradykinesia and difficulty walking, dysphagia, anorexia and hypoferraemic anaemia, SPET revealed a reduction of cerebral perfusion and ENeG results were compatible with a mainly motor polyneuropathy. Extensive laboratory investigations gave positive results for anti-gliadin antibodies, and an appropriate diet led to a progressive remission of the encephalopathy.
Highlights
Coeliac disease is an inflammatory disease of the upper small intestine resulting from gluten ingestion [1]
Many cases of coeliac disease long remain in a subclinical stage [2], or undiagnosed because of poor awareness of the condition among primary care physicians [1]
The diagnostic process in this patient proved complicated. This is, a case of clinical onset of coeliac disease in adulthood, without signs of malabsorption and with exclusively psychiatric involvement. This clinical picture could be attributed to the SPET-documented frontal hypoperfusion
Summary
Coeliac disease is an inflammatory disease of the upper small intestine resulting from gluten ingestion [1]. In a significant proportion of cases (10–15%) gluten intolerance can be associated with central or peripheral nervous system disorders, such as cerebellar ataxia, myoclonus, epilepsy, ophthalmoplegia, dementia, multifocal leukoencephalopathy, peripheral neuropathies and myopathies [3] and with psychiatric disorders such as anxiety, depression, psychotic symptoms and personality disorders [4]. These manifestations are sometimes the presenting symptoms of the disease [4,5,6]. He takes olanzapine 2.5 mg and derives benefit from the treatment
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