P4158 - Understanding Gluten Ataxia in a Newly Diagnosed Celiac Disease Patient: A Case Report

Priya Krishnaprasad, DO, Christine Gallati, MD, Jasjit Dhillon, DO, Bradley Bakst, DO
Christiana Care Health System, Newark, DE

Introduction: Gluten sensitivity encompasses various intra and extraintestinal clinical manifestations of abnormal autoimmune reactivity towards dietary gluten in those who are genetically predisposed. Celiac disease, a T-cell mediated chronic autoimmune condition, is a well-recognized form of gluten sensitivity. However, extraintestinal symptoms can manifest without gastrointestinal complaints which can lead to underdiagnosis. Neurological manifestations, including ataxia and peripheral neuropathy as described in this case, are rare but significant. As providers it is crucial to recognize the varied presentations of gluten sensitivity beyond diarrhea, abdominal pain, and weight loss to aid in earlier diagnosis and treatment for patients.

Case Description/Methods: This case pertains to a 33-year-old male with a history of uncontrolled type 2 diabetes and factitious dermatitis. He presented with a two-month history of progressively worsening uncoordinated gait, falls, dizziness and frequent non-bloody, non-melenic diarrhea daily over the past month. Physical exam revealed right-sided swaying during ambulation and he had a positive Romberg sign. He had decreased proprioception on the right great toe with sensory changes in both lower extremities. Head CT showed no acute abnormalities. Upper endoscopy revealed an erythematous gastric antrum and a normal duodenum. A duodenal biopsy demonstrated an increase in intraepithelial lymphocytes suggestive of celiac disease. Additionally, tissue transglutaminase (TTG) IgG antibody was elevated at 34.7, TTG IgA was < 1.2. Despite leaving against medical advice, the patient reported adherence to a gluten-free diet during follow-up, leading to resolution of his ataxia and improvement in neuropathy symptoms.

Discussion: This case highlights sensory ataxia and neuropathy in a patient with gluten sensitivity that improved after initiating a gluten free diet. Current evidence suggests that the underlying pathophysiology between gluten insensitivity and neurologic manifestations are largely immune mediated, characterized by patchy loss of Purkinje cells in the cerebellar cortex. Further research on diagnostic methods for gluten specific ataxia and neuropathy is needed. Additionally, it is important for providers to have an awareness of the extraintestinal manifestations of celiac disease to aid in earlier diagnosis.


Disclosures:


Priya Krishnaprasad, DO, Christine Gallati, MD, Jasjit Dhillon, DO, Bradley Bakst, DO. P4158 - Understanding Gluten Ataxia in a Newly Diagnosed Celiac Disease Patient: A Case Report, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.