Suppr超能文献

儿童乳糜泻伴周围神经病变:一例报告

Celiac Disease Presenting with Peripheral Neuropathy in Children: A Case Report.

作者信息

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

机构信息

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.

出版信息

Int J Environ Res Public Health. 2017 Jul 14;14(7):785. doi: 10.3390/ijerph14070785.

Abstract

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.

摘要

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。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aefc/5551223/eb625dce60b7/ijerph-14-00785-g001.jpg

相似文献

1
Celiac Disease Presenting with Peripheral Neuropathy in Children: A Case Report.
Int J Environ Res Public Health. 2017 Jul 14;14(7):785. doi: 10.3390/ijerph14070785.
2
Coeliac disease in infants: antibodies to deamidated gliadin peptide come first!
Ital J Pediatr. 2017 Aug 10;43(1):70. doi: 10.1186/s13052-017-0392-6.
3
Celiac disease: risk assessment, diagnosis, and monitoring.
Mol Diagn Ther. 2008;12(5):289-98. doi: 10.1007/BF03256294.
4
Celiac disease or non-celiac gluten sensitivity? An approach to clinical differential diagnosis.
Am J Gastroenterol. 2014 May;109(5):741-6; quiz 747. doi: 10.1038/ajg.2014.41. Epub 2014 Mar 11.
6
Small-fiber neuropathy/neuronopathy associated with celiac disease: skin biopsy findings.
Arch Neurol. 2005 Oct;62(10):1574-8. doi: 10.1001/archneur.62.10.1574.
7
Diagnosis and classification of celiac disease and gluten sensitivity.
Autoimmun Rev. 2014 Apr-May;13(4-5):472-6. doi: 10.1016/j.autrev.2014.01.043. Epub 2014 Jan 15.
8
Accuracy in Diagnosis of Celiac Disease Without Biopsies in Clinical Practice.
Gastroenterology. 2017 Oct;153(4):924-935. doi: 10.1053/j.gastro.2017.06.002. Epub 2017 Jun 15.
9
[Celiac disease in children from the northwest of Mexico: clinical characteristics of 24 cases].
Rev Gastroenterol Mex. 2013 Oct-Dec;78(4):211-8. doi: 10.1016/j.rgmx.2013.07.005. Epub 2013 Nov 7.
10
The anti-deamidated gliadin peptide antibodies unmask celiac disease in small children with chronic diarrhoea.
Dig Liver Dis. 2011 Jun;43(6):465-9. doi: 10.1016/j.dld.2010.12.006. Epub 2011 Jan 22.

引用本文的文献

1
Evaluation of Frequency of Celiac Disease in Children with Idiopathic Epilepsy.
Iran J Child Neurol. 2024 Fall;18(4):61-70. doi: 10.22037/ijcn.v18i1.36844. Epub 2024 Sep 29.
2
Celiac disease - a pluripathological model in pediatric practice.
Front Immunol. 2024 Apr 23;15:1390755. doi: 10.3389/fimmu.2024.1390755. eCollection 2024.
5
Acrodystrophic axonal polyneuropathy with celiac disease: a case report.
J Med Case Rep. 2021 Dec 18;15(1):615. doi: 10.1186/s13256-021-03171-z.
6
Peripheral nerve disease secondary to systemic conditions in children.
Ther Adv Neurol Disord. 2019 Aug 12;12:1756286419866367. doi: 10.1177/1756286419866367. eCollection 2019.

本文引用的文献

1
Transverse Myelitis as Manifestation of Celiac Disease in a Toddler.
Pediatrics. 2017 Mar;139(3). doi: 10.1542/peds.2016-1381. Epub 2017 Feb 2.
2
Guillain-Barré syndrome.
Autoimmun Rev. 2017 Jan;16(1):96-101. doi: 10.1016/j.autrev.2016.09.022. Epub 2016 Sep 23.
3
[Update on celiac disease].
Rev Med Chil. 2016 Feb;144(2):211-21. doi: 10.4067/S0034-98872016000200010.
4
Celiac disease in a large cohort of children and adolescents with recurrent headache: A retrospective study.
Dig Liver Dis. 2016 May;48(5):495-498. doi: 10.1016/j.dld.2015.12.015. Epub 2015 Dec 31.
5
Celiac disease in children.
Clin Res Hepatol Gastroenterol. 2015 Oct;39(5):544-51. doi: 10.1016/j.clinre.2015.05.024. Epub 2015 Jul 15.
6
The Frequency of Epileptiform Discharges in Celiac Disease.
Pediatr Neurol. 2015 Jul;53(1):78-82. doi: 10.1016/j.pediatrneurol.2015.02.006. Epub 2015 Apr 3.
7
Risk of Neuropathy Among 28,232 Patients With Biopsy-Verified Celiac Disease.
JAMA Neurol. 2015 Jul;72(7):806-11. doi: 10.1001/jamaneurol.2015.0475.
8
Peripheral neuropathies of rheumatologic disease and gluten-related disorders.
Semin Neurol. 2014 Sep;34(4):413-24. doi: 10.1055/s-0034-1390390. Epub 2014 Nov 4.
9
A pediatric case of gluten sensitivity with severe neurological presentation.
Eur J Pediatr. 2014 Dec;173(12):1699-702. doi: 10.1007/s00431-014-2331-5. Epub 2014 May 13.

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍。

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索

文档翻译

学术文献翻译模型,支持多种主流文档格式。

立即体验