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A pediatric case of gluten sensitivity with severe neurological presentation

R Jorge1, C Aguiar, C Espinheira

  • 1Department of Pediatrics, São João Hospital Centre, Alameda Prof. Hernâni Monteiro, 4200 - 319, Porto, Portugal, ritamilheiro@hotmail.com.

European Journal of Pediatrics
|May 14, 2014
PubMed

Insights

Gluten sensitivity can cause severe neurological issues in children, even without digestive symptoms. A gluten-free diet effectively resolved symptoms and halted brain lesion progression in a young girl.

Area of Science:

  • Pediatric Neurology
  • Autoimmune Disorders
  • Gastroenterology

Background:

  • Neurologic manifestations are recognized in adult celiac disease patients, but are considered rare in children.
  • Gluten sensitivity can present with neurological symptoms, sometimes preceding gastrointestinal issues.

Observation:

  • A 3-year-old girl presented with severe neurological symptoms and white matter lesions on MRI, mimicking acute disseminated encephalomyelitis.
  • The patient had no gastrointestinal symptoms, but elevated IgA anti-transglutaminase (TG) 2 antibodies and duodenal biopsy confirmed celiac disease.
  • Recurrent neurological symptoms and lesions prompted consideration of an autoimmune/inflammatory systemic disease.

Findings:

  • A gluten-free diet led to complete resolution of the child's neurological manifestations.
  • The gluten-free diet also halted the progression of white matter lesions observed on cerebral MRI.

Implications:

  • Testing for anti-TG2 autoantibodies is recommended for children with unexplained neurological issues of probable autoimmune origin to identify potential gluten sensitivity.
  • A gluten-free diet is the primary and effective treatment for gluten sensitivity, regardless of symptom presentation.
  • Further research is needed on pediatric neurological manifestations of gluten sensitivity and their response to dietary intervention.
Abstract

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