[Psychosis revealing a silent celiac disease in a young women with trisomy 21].
BACKGROUND
Down's syndrome is characterized by an abnormal frequency of coeliac disease and by the frequent occurrence of neurological disorders such as Alzheimer-type dementia of early onset. However, psychosis is rare in Down's syndrome.


METHODS
We report the case of a 41-year-old woman, who presented with Down's syndrome. She was living with her parents and had a normal social life. She suddenly experienced some esthesic hallucinations, depression, anorexia, affective flattening and autistic behavior. Biological evaluation revealed macrocytosis, polyclonal IgA and IgG hypergammaglobulinemia and strong positivity for anti-gliadin antibodies of IgG and IgA isotypes. Brain CTscan was normal. Since digestive specimen biopsies did not evidence villous atrophy, we concluded in a silent coeliac disease. After 12 months of gluten-free diet a spectacular and lasting improvement of both psychotic and depressive symptoms was obtained.


CONCLUSIONS
The effects of abnormal interaction between the immune system and gluten can be expressed not only in the gut (coeliac disease) but also in the brain (psychosis) in genetically predisposed patients, such as those suffering from Down's syndrome. There was evidence for brain disorder related to coeliac disease in our patient.


CONCLUSIONS
Our case report shows that, before concluding in Alzheimer-type dementia in Down's syndrome, a biological search for coeliac disease is useful since a gluten-free diet may improve the psychiatric symptoms.
Serratrice
Jacques
J
Service de médecine interne, Hôpital de la Timone Marseille.
Disdier
Patrick
P
Kaladjian
Arthur
A
Granel
Brigitte
B
Azorin
Jean Michel
JM
Laugier
René
R
Berenguer
Michel
M
Weiller
Pierre Jean
PJ
D000328:Adult; D002446:Celiac Disease / Q000178:diet therapy / Q000209:etiology*; D003863:Depression / Q000178:diet therapy / Q000209:etiology; D004032:Diet; D004314:Down Syndrome / Q000150:complications* / Q000523:psychology; D005260:Female; D005983:Glutens; D006801:Humans; D011618:Psychotic Disorders / Q000178:diet therapy / Q000209:etiology*; D016896:Treatment Outcome
D005983:Glutens