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A case of multiple sclerosis with atypical onset associated with autoimmune hepatitis and silent coeliac disease

Maria Teresa Ferrò1, Diego Franciotta, Tommaso Riccardi

  • 1Neurological Department Ospedale Maggiore, Multiple Sclerosis Center, L.go Dossena 2, 26013 Crema, Italy. maraferro@libero.it

Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
|April 2, 2008
PubMed

Insights

Multiple sclerosis (MS) and coeliac disease (CD) are rarely linked. This case highlights an unusual association of MS with acute hepatitis and undiagnosed coeliac disease, suggesting a potential gluten-triggered neurological impact.

Area of Science:

  • Neurology
  • Gastroenterology
  • Immunology

Background:

  • Multiple sclerosis (MS) and coeliac disease (CD) share uncommon associations.
  • Recent studies link MS-like illness and CNS white-matter abnormalities to CD.
  • Investigating co-occurring autoimmune conditions is crucial for understanding disease mechanisms.

Observation:

  • A 19-year-old female with MS presented with headache and later acute hepatitis (AH).
  • Occult CD was diagnosed via jejunal biopsy, with constipation as the sole GI symptom.
  • Pre-MS onset serum was positive for CD; anti-CNS antibodies were negative.

Findings:

  • The patient exhibited a rare combination of MS, AH, and CD.
  • CD was present before MS onset, indicated by retrospective serology.
  • Atypical MS onset and AH suggest a complex interplay of factors.

Implications:

  • While a chance association is possible, gluten-triggered immune-mediated CNS damage in MS cannot be ruled out.
  • This case underscores the importance of considering CD in patients with neurological disorders, especially with atypical presentations.
  • Further research is needed to explore the potential role of gluten in MS pathogenesis.

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