Gluten encephalopathy with psychiatric onset: case report

Area of Science:

• Neurology
• Gastroenterology
• Immunology

Background:

• Coeliac disease, an autoimmune disorder triggered by gluten, often presents subclinically or undiagnosed.
• A significant percentage of coeliac disease patients experience neurological and psychiatric complications.
• Gluten intolerance can manifest with diverse central and peripheral nervous system disorders.

Purpose of the Study:

• To investigate the neurological and psychiatric manifestations of coeliac disease.
• To highlight the association between gluten intolerance and severe neuropsychiatric symptoms.
• To demonstrate the efficacy of a gluten-free diet in managing coeliac disease-related encephalopathy.

Main Methods:

• Case study of a 38-year-old male with worsening anxiety and behavioral changes.
• Diagnostic workup including neuroimaging (SPET) and electrophysiological tests (ENeG).
• Extensive laboratory investigations for autoimmune markers, including anti-gliadin antibodies.

Main Results:

• Patient presented with symptoms suggestive of Neuroleptic Malignant Syndrome, followed by cognitive deficits, motor impairment, and anemia.
• SPET revealed reduced cerebral perfusion, and ENeG indicated a motor polyneuropathy.
• Positive anti-gliadin antibodies confirmed coeliac disease, and a gluten-free diet led to progressive remission of encephalopathy.

Conclusions:

• Coeliac disease can present with severe and complex neurological and psychiatric disorders.
• Early identification of anti-gliadin antibodies and prompt dietary intervention are critical.
• A gluten-free diet is effective in reversing neurological and psychiatric symptoms associated with coeliac disease.