Gluten and Neuroimmunology. Rare association with Myasthenia Gravis and Literature Review

• Main Authors: Francisco Oliveira, Vinicius Schoeps, Wilson Sanvito, Berenice Valerio
• Format: Article
• Language: English
• Published: Associação Médica Brasileira
• Series: Revista da Associação Médica Brasileira
• Subjects: Celiac disease; Glutens; Myasthenia gravis; Autoimmune diseases
• Online Access: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-42302018000400311&lng=en&tlng=en

SUMMARY As the celiac disease (CD), the non-celiac gluten sensitivity (NCGS) has also been associated with several autoimmune manifestations. It is rarely associated with myasthenia gravis (MG). This paper shall introduce the case of a young female patient, initially presenting a peripheral neuropathy framework. During clinical and neurological follow-up, she began to present symptoms of various immune-mediated morbidities. Diseases related to gluten represent a clinical spectrum of manifestations with a trigger in common, the ingestion of gluten. CD is the most well-known and serious disease of the spectrum, also called gluten-sensitive enteropathy. The NCGS is diagnosed from clinical evidence of improvement in symptoms followed by a Gluten Free Diet (GFD) in patients without signs of enteropathy in duodenal biopsy. There are indications that, although rare, with a prevalence of 1 in 5000, myasthenia gravis (MG) may occur more often when CD is also present. Between 13 to 22% of the patients with MG have a second autoimmune disorder. However, it is often associated with dermatomyositis or polymyositis, lupus erythematosussystemic lupus erythematosus, Addison’s disease, Guillain-Barré syndrome and juvenile rheumatoid arthritis. Thus, the symptoms of neuromuscular junction involvement may give a diagnostic evidence of this rare association.