Pacitto Alessandra, Paglino Alessandra, Di Genova Lorenza, Leonardi Alberto, Farinelli Edoardo, Principi Nicola, di Cara Giuseppe, Esposito Susanna
Pediatric Clinic, Università degli Studi di Perugia, 06132 Perugia, Italy.
Pediatric Highly Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, 20122 Milan, Italy.
Int J Environ Res Public Health. 2017 Jul 14;14(7):785. doi: 10.3390/ijerph14070785.
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. 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. 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.
患有乳糜泻(CD)的儿童出现具有临床相关性的神经表现并不常见,尤其是当这些表现被视为疾病发作的迹象时。本文报道了一例23个月大的儿童以吉兰 - 巴雷综合征(GBS)作为CD的首发表现。我们描述了一名23个月大的保加利亚男孩,其CD发病伴有周围神经病变,表现为突然拒绝行走且双下肢深腱反射消失。在出现神经症状的两个月前,该男孩出现了诸如呕吐、腹胀等胃肠道症状,以及明显的营养不良和体重减轻迹象。当我们在症状出现六个月后对该儿童进行评估时,临床和实验室检查结果显示出与营养不良相关的周围神经病变的明显迹象。因此,检测了血清去酰胺化麦醇溶蛋白和组织转谷氨酰胺酶抗体。抗麦醇溶蛋白水平比正常水平高出十六倍以上,IgA抗转谷氨酰胺酶水平比正常水平高出四倍。抗肌内膜抗体呈阳性,人类白细胞抗原(HLA)II分型证实了对CD的遗传易感性(DQ2阳性,DQ8阴性)。鉴于疾病的临床证据与乳糜泻筛查试验结果之间的关联,在未进行肠病活检确诊的情况下做出了CD的诊断。该儿童开始了严格的无麸质饮食,三个月后饮食导致周围神经病变完全恢复,行走、反射功能恢复正常,整体状况得到改善。我们的病例强调了CD与儿童周围神经病变作为首发症状之间罕见但可能的关联,即使没有胃肠道表现,这表明在儿童周围神经病变的鉴别诊断中应始终考虑CD。充分了解CD的肠外表现对于迅速引入可能有助于缓解神经症状的无麸质饮食至关重要。