Reversible inflammatory and vacuolar myopathy with vitamin E deficiency in celiac disease

Abstract

We report a patient with late-onset celiac disease and neurological manifestations including myopathy, polyneuropathy, and ataxia. Laboratory investigations showed anti-gliadin antibodies and severe vitamin E deficiency. Muscle biopsy revealed inflammatory infiltrates and rimmed vacuoles, similar to those found in inclusion-body myositis. A gluten-free diet and vitamin E supplementation reversed both the clinical neurological manifestations and the abnormalities in the muscle biopsy. Anti-gliadin antibodies were no longer present. This case illustrates the spectrum of neurological complications of celiac disease and documents the occurrence of reversible pathology resembling inclusion-body myopathy in the muscle.

Proximal Limb Weakness in a Patient with Celiac Disease: Copper Deficiency, Gluten Sensitivity, or Both as the Underlying Cause?

“…It has been described in patients with vitamin D and E deficiencies accompanying CD [15, 16]. Hadjivassiliou et al proposed that myopathy may represent an extraintestinal manifestation of gluten sensitivity and that it may have an immune mechanism [17].…”

Correlation between neurological dysfunction with vitamin E deficiency and gastrectomy

“…Further study is necessary to elucidate this mechanism. Neurological symptoms that result from vitamin E deficiency include cerebellar ataxia, peripheral neuropathy, and myopathy [11][12][13][14][15][16][17][18][19][20]. Vitamin E plays a role in the stabilization of cell membranes due to its antioxidant activities [21].…”

Celiac disease manifested by polyneuropathy and swollen ankles

“…The real cause of polyneuropathy as one of the extraintestinal CD signs is not known. Some authors suppose that certain vitamin deficiency (especially in B6, B12, and E) can play a major etiological role [12][13][14] . Antiganglioside antibodies were found in 65% of adults with CD and polyneuropathy [15] .…”