Gluten and Neuroimmunology. Rare association with Myasthenia Gravis and Literature Review

SUMMARY As the celiac disease (CD), the non-celiac gluten sensitivity (NCGS) has also been associated with several autoimmune manifestations. It is rarely associated with myasthenia gravis (MG). This paper shall introduce the case of a young female patient, initially presenting a peripheral neuropathy framework. During clinical and neurological follow-up, she began to present symptoms of various immune-mediated morbidities. Diseases related to gluten represent a clinical spectrum of manifestations with a trigger in common, the ingestion of gluten. CD is the most well-known and serious disease of the spectrum, also called gluten-sensitive enteropathy. The NCGS is diagnosed from clinical evidence of improvement in symptoms followed by a Gluten Free Diet (GFD) in patients without signs of enteropathy in duodenal biopsy. There are indications that, although rare, with a prevalence of 1 in 5000, myasthenia gravis (MG) may occur more often when CD is also present. Between 13 to 22% of the patients with MG have a second autoimmune disorder. However, it is often associated with dermatomyositis or polymyositis, lupus erythematosussystemic lupus erythematosus, Addison's disease, Guillain-Barré syndrome and juvenile rheumatoid arthritis. Thus, the symptoms of neuromuscular junction involvement may give a diagnostic evidence of this rare association.

Enfermedad celíaca del adulto / Adult celiac disease

Celiac disease is a chronic enteropathy caused by intolerance to gluten. The true prevalence of this condition is much greater than previously recognized, with more silent cases being diagnosed and a greater proportion of cases diagnosed later in adulthood. It presents with a spectrum of clinical manifestations and histological abnormalities. Duodenal biopsy remains the gold standard for diagnosis of celiac disease, even though there are new serologic tests that are very specific. Correlation of clinical, serologic, and histological features are essential for a definitive diagnosis of celiac disease. The pathogenesis consists in an interaction between genetic, immunologic and environmental factors, which interact with HLA molecules to activate an immunologic response in the small bowel mucosa causing tissue damage. The main treatment is a free gluten diet. Health risks for untreated celiac disease appear to be greater compared with those patients who adhere to this treatment.