The clinical, imaging, intestinal pathological characteristics of gluten ataxia: a case report in Chinese mainland

Objective To investigate the clinical, imaging, intestinal pathological characteristics and prognosis of gluten ataxia (GA). Methods The clinical data, treatment and prognosis in a patient with GA that was confirmed by pathology and hospitalized in the Department of Neurology, China-Japan Friendship Hospital in July 2018, were analyzed retrospectively. The related literature was reviewed and the clinical feature was summarized. Results The patient is a 41-year old man. He suffered from progressive cerebellar ataxia, and the brain magnetic resonance imaging exhibited diffused cerebellar atrophy. Serum human leukocyte antigen (HLA) tests showed that the patient carried HLA-DQ2 genotype. IgA type anti-gliadin antibody was positive (39.39 RU/ml). Duodenoscopy biopsy revealed mild villus atrophy and lymphocytic infiltration, indicating celiac disease. The diagnosis of GA was established then and the patient was administered gluten-free diet combined with intravenous immunoglobulin, which markedly improved the cerebellar symptoms and signs of cerebellar speech, walk capability and daily living activities. He could do long distance driving independently two months later. Conclusions GA is one of immune-mediated reversible acquired cerebellar ataxia caused by gluten sensitivity. The genotype, serologic features, and clinical phenotype of GA in Chinese mainland population might be similar with those in European and American countries. Key words: Cerebellar ataxia; Glutens; Celiac disease; Biopsy; Anti-gliadin antibodies