Transverse myelitis ID'd as manifestation of celiac Dx in child
Hilde Krom, M.D., from Emma Children's Hospital in Amsterdam, and colleagues present the case of a 17-month-old girl with rapidly progressive unwillingness to sit, stand, play, and walk. In addition, she lacked appetite, lost weight, vomited, and had iron deficiency.
The authors describe a cachectic, irritable girl with a distended abdomen, dystrophic legs with paraparesis, disturbed sensibility, and areflexia on physical examination. Abnormal high signal intensity on T2-weighted images in the cord on the thoracic level, without cerebral abnormalities, was seen on magnetic resonance imaging, which indicated TM. Elevated immunoglobulin A antibodies against gliadin and tissue transglutaminase were seen on laboratory investigations. Gastroscopy showed villous atrophy in the duodenal biopsies and lymphocytic gastritis according to Marsh IIIb; these findings were compatible with CD. The patient recovered completely after the start of a gluten-free diet and methylprednisolone.
"To our knowledge, this is the first pediatric case of TM as manifestation of CD," the authors write. "We suggest that all children with TM or other neurologic manifestations of unknown origin should be screened for CD."
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