title: Multineuropathy in a patient with HBV infection, polyarteritis nodosa and celiac disease.
abstract: We report on the first association of celiac disease, polyarteritis nodosa and HBV infection in a patient who developed a neuropathy. On admission his general and neurological conditions were severely compromised. Haematological test revealed HBV infection and high levels of antibodies to tissue transglutaminase, endomysium, gliadin. EMG showed sensory-motor asymmetric axonal neuropathy. A sural nerve biopsy revealed fibre loss, axonal degeneration with asymmetrical distribution and fascicular ischaemia. A duodenal biopsy was consistent with celiac disease. The patient was treated with immunosuppressive and antiviral therapy, and gluten-free diet with good result. Celiac disease can be related to a higher risk of autoimmune disorders and may have contributed to the development of multineuropathy in this patient.
authors.affiliation: Department of Neurological Sciences, University of Verona, Verona, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Squintani
authors.forename: Sergio
authors.initials: S
authors.lastname: Ferrari
authors.forename: Paola
authors.initials: P
authors.lastname: Caramaschi
authors.forename: Tiziana
authors.initials: T
authors.lastname: Cavallaro
authors.forename: Nicola
authors.initials: N
authors.lastname: Refatti
authors.forename: Nicola
authors.initials: N
authors.lastname: Rizzuto
authors.forename: Paola
authors.initials: P
authors.lastname: Tonin
mesh_terms: D000906:Antibodies / Q000276:immunology; D000998:Antiviral Agents / Q000627:therapeutic use; D002446:Celiac Disease / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D055050:Diet, Gluten-Free; D005903:Gliadin / Q000276:immunology; D006509:Hepatitis B / Q000150:complications* / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010488:Polyarteritis Nodosa / Q000150:complications* / Q000473:pathology; D011115:Polyneuropathies / Q000473:pathology*; D011503:Transglutaminases / Q000276:immunology; D016896:Treatment Outcome
chemical_list: D000906:Antibodies; D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D005903:Gliadin; D011503:Transglutaminases