The electronic version of this article is the complete one and can be found online at:http://www.cpementalhealth.com/content/5/1/16
Received:    7 July 2008
Accepted:    26 June 2009
Published:    26 June 2009

© 2009 Poloni et al; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract

Many cases of coeliac disease, a gastrointestinal autoimmune disorder caused by sensitivity to gluten, can remain in a subclinical stage or undiagnosed. In a significant proportion of cases (10–15%) gluten intolerance can be associated with central or peripheral nervous system and psychiatric disorders.

A 38-year-old man was admitted as to our department an inpatient for worsening anxiety symptoms and behavioural alterations. After the addition of second generation antipsychotic to the therapeutic regimen, the patient presented neuromotor impairment with high fever, sopor, leukocytosis, raised rhabdomyolysis-related indicators. Neuroleptic malignant syndrome was strongly suspected. After worsening of his neuropsychiatric conditions, with the onset of a frontal cognitive deficit, bradykinesia and difficulty walking, dysphagia, anorexia and hypoferraemic anaemia, SPET revealed a reduction of cerebral perfusion and ENeG results were compatible with a mainly motor polyneuropathy. Extensive laboratory investigations gave positive results for anti-gliadin antibodies, and an appropriate diet led to a progressive remission of the encephalopathy.

Introduction

Coeliac disease is an inflammatory disease of the upper small intestine resulting from gluten ingestion [1]. The diagnosis is based on: a clinical picture suggesting malabsorption of nutrients, serology for anti-gliadin, anti-endomysial and anti-transglutaminase antibodies, sometimes a biopsy of the intestinal mucosa, and resolution of the lesions following the institution of a gluten-free diet [1]. Many cases of coeliac disease long remain in a subclinical stage [2], or undiagnosed because of poor awareness of the condition among primary care physicians [1]. In a significant proportion of cases (10–15%) gluten intolerance can be associated with central or peripheral nervous system disorders, such as cerebellar ataxia, myoclonus, epilepsy, ophthalmoplegia, dementia, multifocal leukoencephalopathy, peripheral neuropathies and myopathies [3] and with psychiatric disorders such as anxiety, depression, psychotic symptoms and personality disorders [4]. These manifestations are sometimes the presenting symptoms of the disease [4-6]. The physiopathological mechanisms underlying these associations are still not known, even though genetic causes [6] and autoimmune factors [7,8] have been hypothesised.