Case Study Details Undiagnosed Adult Celiac Disease Presenting as Behavioral Disturbances

Celiac.com 01/27/2021 - The effects of celiac disease are typically gastrointestinal, though there have been rare cases where celiac disease can manifest with psychiatric symptoms and behavioral disturbances.

In one recent case, a woman with untreated celiac disease experienced psychotic delusions when eating gluten. The delusions left her isolated from family and friends, and led to psychiatric treatment, diagnosis of celiac disease, and adoption of a gluten-free diet. After improving, accidental gluten consumption caused another break that led to a homicide attempt on her parents.

Celiac.com Sponsor (A12):
In an unrelated matter, a team of researchers recently reported on the case of a 25-year-old man with a history of schizophrenia and autism spectrum disorder who was seen for behavioral disturbance after breaking into a neighboring house to eat food. 

The research team included Andrew K. Murphy, Joseph A. Norton, and Benjamin R. Pflederer. They are affiliated with the Department of Medicine at the University of Illinois College of Medicine in Peoria, Illinois.

The male patient reported several months of diarrhea and fecal incontinence, and was severely malnourished on exam, despite eating sufficient food. 

These days, with better celiac awareness and testing, it's uncommon for patients to present with celiac crisis, which is marked by profuse diarrhea and severe metabolic/nutritional disturbances. 

Interestingly, behavioral disturbances, such as increased aggression or anxiety, are often the main manifestation of celiac disease in children, with gastrointestinal symptoms being milder or absent.

A blood screen showed high tissue transglutaminase IgA antibody (TTG) and gliadin IgA levels, and celiac disease was confirmed by biopsy. 

The patient began a lactose-free and gluten-free diet, and received a short course of total parenteral nutrition (TPN) for nutritional resuscitation. He improved rapidly with this treatment, and his nutrition and behavior returned to baseline.

This report of a case in which an adult with psychiatric comorbidities manifesting mainly as behavioral disturbances more common in children. 

Such patients can show highly atypical symptoms, and clinicians should watch carefully for such cases.

Read more at: Am J Case Rep 2020; 21:e928337