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Rev Assoc Med Bras (1992). 2018 Apr;64(4):311-314. doi: 10.1590/1806-9282.64.04.311.
Gluten and Neuroimmunology. Rare association with Myasthenia Gravis and Literature Review.
Oliveira F1, Schoeps V1, Sanvito W1, Valerio B2.

Abstract

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.