Case Report
Copyright ©2007 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 14, 2007; 13(18): 2636-2638
Published online May 14, 2007. doi: 10.3748/wjg.v13.i18.2636
Celiac disease manifested by polyneuropathy and swollen ankles
Zlatko Djuric, Borislav Kamenov, Vuka Katic
Zlatko Djuric, Children's Hospital, Department of Gastroenterology, University of Nis School of Medicine, Nis, Serbia
Borislav Kamenov, Children's Hospital, Department of Immunology, University of Nis School of Medicine, Nis, Serbia
Vuka Katic, Institute of Pathology, University of Nis School of Medicine, Nis, Serbia
Author contributions: All authors contributed equally to the work.
Correspondence to: Zlatko Djuric, PhD, Children's Hospital, Department of Gastroenterology, University of Nis School of Medicine, Dr. Zoran Djindjic Blv. 48, Nis 18000,Serbia. zldjuric@yahoo.com
Telephone: +381-18-231922 Fax: +381-18-231922
Received: March 10, 2007
Revised: March 12, 2007
Accepted: March 26, 2007
Published online: May 14, 2007
Abstract

A 27-year-old male started to have his ankles swollen during his military service. He was examined at a military hospital where electromyoneurography showed the signs of distal sensory-motor polyneuropathy with axon demyelinization and weak myopathic changes, whereas histopathological examination of gastrocnemius muscle biopsy revealed some mild and nonspecific myopathy. Besides, he was found to have subcutaneous ankle tissue edemas and hypertransaminasemia. Due to these reasons, he was dismissed from the military service and examined at another hospital where bone osteodensitometry revealed low bone mineral density of the spine. However, his medical problems were not resolved and after the second discharge from hospital he was desperately seeing doctors from time to time. Finally, at our institution he was shown to have celiac disease (CD) by positive serology (antitissue transglutaminase and antiendomysial antibodies) and small bowel mucosal histopathological examination, which showed total small bowel villous atrophy. Three months after the initiation of gluten-free diet, his ankle edema disappeared, electromyoneurographic signs of polyneuropathy improved and liver aminotransferases normalized. Good knowledge of CD extraintestinal signs and serologic screening are essential for early CD recognition and therapy.

Keywords: Celiac; Polyneuropathy; Swollen ankles