Osteomalacic myopathy due to celiac disease

Celiac disease is a gluten-sensitive enteropathy characterized by malabsorption resulting from inflammatory injury to the mucosa of the small intestine. It is well known to be associated with a variety of neurological disorders including epilepsy, myopathy, neuropathy and ataxia. The nature of this association is unclear. Although osteomalacia secondary to vitamin D deficiency is a recognized complication of celiac disease, however, severe osteomalacic myopathy as the only presentation of celiac disease is extremely rare. We present 2 interesting cases of osteomalacic myopathy secondary to celiac disease, which were treated successfully with full recovery. An important and unique observation was the brisk reflexes noticed in both patients. The mechanism behind this phenomenon is not well understood. Work-up for celiac disease is warranted in any young patient that presents with myopathy.