case of concurrent multiple sclerosis and celiac disease

ABSTRACT

Multiple sclerosis [MS] is an autoimmune inflammatory process that affects the central nervous system [CNS]. Celiac disease [CD] is a systemic autoimmune disorder of gluten intolerance. Based on the presumed association of MS with multiple autoimmune processes, the coincidence of MS with gluten sensitivity has been investigated with controversial results. Here, we report a known case of MS with mild gastrointestinal symptoms and spontaneous abortions. Thorough paraclinical evaluations revealed iron deficiency anemia and high titers of tissue transglutaminase antibody [tTG]. A small bowel biopsy demonstrated changes compatible with CD, MARSH type 3c. Based on the serologic results and biopsy findings, a diagnosis of CD was established and the patient was instructed to consume a gluten-free diet. Gastrointestinal symptoms abated and her serum levels of tTG normalized, along with improvement in the patient's iron profile during follow ups. The combined presence of MS and CD is a rare situation for which previous studies have failed to clarify the existence of any correlation between MS and CD. Thus, further investigation of CD in MS patients with gastroenterological complaints is recommended.