Restless leg syndrome in a patient with celiac disease: a coincidence or an association?

Abstract

To the Editor: A myriad of extraintestinal manifestations of celiac disease have been described,1 but none have included restless leg syndrome (RLS). We report a case of celiac disease presenting with RLS. A 45-year-old woman was seen in June 2007 for exacerbation of sleep discomfort related to an uncomfortable sensation in the limbs at night that also resulted in daytime somnolence. The sensation decreased with movement and disappeared with walking. She also reported abdominal pain and diarrhea. Repeated colonoscopies in 2002 and 2006 were normal. Her medical history revealed a long-standing anemia refractory to oral iron supplementation and weight loss. A neurological exam was normal. Initial laboratory studies showed a hemoglobin of 9.8 g/dL (reference range, 13-15 g/dL) with a mean corpuscular volume of 82 fL, a mean corpuscular hemoglobin of 26.5 pg/cell (reference range, 3033 pg/cell) serum iron of 11.3 μmol/L (normal range, 8.8-32.4 μmol/L) and serum ferritin of 6.2 ng/mL (normal range, 30-400 ng/mL). Thyroid stimulating hormone, folic acid and vitamin B12 levels were normal. Her 25-hydroxyvitamin D was 7.2 ng/mL (normal, >20 ng/mL). Bone mass densitometry revealed osteoporosis at the spinal level (T score, −3.2). IgA endomysial antibodies and IgA tissue transglutaminase antibodies (>200 RU/mL, normal <20 RU/mL), and IgA antigliadin antibodies (30 UI/mL, normal <5 UI/mL) were positive. Upper gastrointestinal endoscopy revealed an atrophic duodenal mucosa. Duodenal biopsy showed severe villous atrophy with mononuclear infiltrate and epithelial cell damage. A diagnosis of celiac disease with secondary RLS was made. A gluten-free diet and intravenous iron supplementation abated the symptoms of RLS in 6 weeks. At the 6-month visit she had gained 8 kilograms and her serum ferritin level was 57 ng/mL. The patient was diagnosed as having secondary RLS and received parenteral iron supplementation for 5 days.