Gluten sensitivity masquerading as systemic lupus erythematosus.
METHODS
Three patients are described whose original presentation and immunological profile led to the erroneous diagnosis of systemic lupus erythematosus. The correct diagnosis of gluten sensitivity was made after years of treatment with steroids and other immunosuppressive drugs.


CONCLUSIONS
The immunological profile of IgA deficiency and/or raised double stranded DNA in the absence of antinuclear factor together with raised inflammatory markers and symptoms suggestive of an immune diathesis should alert the physician to the possibility of gluten sensitivity. The presence of an enteropathy is no longer a prerequisite for the diagnosis of gluten sensitivity, which can solely present with extraintestinal symptoms and signs. Knowledge of the diverse manifestations of gluten sensitivity is essential in avoiding such misdiagnosis.
Department of Neurology, The Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK. m.hadjivassiliou@sheffield.ac.uk
M
M
Hadjivassiliou
D S
DS
Sanders
R A
RA
Grünewald
M
M
Akil
D001323:Autoantibodies / Q000097:blood; D001799:Blood Sedimentation; D002446:Celiac Disease / Q000175:diagnosis* / Q000178:diet therapy; D003951:Diagnostic Errors; D004032:Diet; D005260:Female; D005903:Gliadin / Q000276:immunology; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D007074:Immunoglobulin G / Q000097:blood; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis* / Q000188:drug therapy; D008875:Middle Aged
D001323:Autoantibodies; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D005903:Gliadin