title: [Refractory encephalitis because of seronegative celiac disease: a case report].
abstract: BACKGROUND
  The celiac disease is an autoimmune bowel disease trigger by gliadine proteins, that can has systemic involvement with varied neurological manifestation since polineuropathy, ataxia, epilepsy, migraine to encephalitis. The aim of the current work is to report a case of possible refractory encephalitis due to celiac disease.
  
  
  METHODS
  A 45 years-old man with histopathologic diagnosis of celiac disease but negative celiac antibodies developed encephalic, brainstem and periphery nervous system manifestations: cognitive declaim and seizures, diplopia and ataxia, polyneuropathy and polyradiculopathy respectively; inflammatory cebrospinal fluid and cortico-subcortical and multiple brainstem lesions with mild contrast enhancement; the neurologic deficits progress in spite of gluten a free diet and immuno-suppressive treatment. During the illness process some pathologies with nervous system and intestinal involvement were discarded: sarcoidosis, systemic lupus; Sjogren syndrome, paraneoplastic syndromes, Whipple disease, AIDS and B12 vitamin deficit.
  
  
  CONCLUSIONS
  The encephalitis is an infrequent clinical manifestation of the celiac disease despite the high prevalence of the celiac disease in the general population. It presents with numerous differential diagnosis, with requires high suspicious diagnosis.
authors.affiliation: Sanatorio de la Trinidad Quilmes, Quilmes, Argentina.
authors.forename: Federico A
authors.initials: FA
authors.lastname: Filippín
authors.affiliation: Sanatorio de la Trinidad Quilmes, Quilmes, Argentina.
authors.forename: Alejandra
authors.initials: A
authors.lastname: Alfonso
authors.affiliation: Sanatorio de la Trinidad Quilmes, Quilmes, Argentina.
authors.forename: Héctor
authors.initials: H
authors.lastname: López-Presas
mesh_terms: D001323:Autoantibodies / Q000097:blood; D001327:Autoimmune Diseases / Q000175:diagnosis; D001361:Avitaminosis / Q000175:diagnosis; D001921:Brain / Q000473:pathology; D002446:Celiac Disease / Q000150:complications* / Q000175:diagnosis / Q000276:immunology / Q000628:therapy; D003937:Diagnosis, Differential; D055050:Diet, Gluten-Free; D018450:Disease Progression; D004660:Encephalitis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000276:immunology; D017809:Fatal Outcome; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D020363:Limbic Encephalitis / Q000175:diagnosis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011129:Polyradiculoneuropathy / Q000209:etiology / Q000276:immunology; D008061:Whipple Disease / Q000175:diagnosis
chemical_list: D001323:Autoantibodies; D007166:Immunosuppressive Agents