The First Japanese Case Of Biopsy-Confirmed Small-Fiber Neuropathy Related To Celiac Disease

A 26-year-old lady presented with a rapidly progressive burning pain in both feet. She had been bothered by bloating after wheat-containing foods since the age of 21. Her gastrointestinal symptoms alleviated after introducing gluten-free diet. On admission, neurological examination was unremarkable without dysesthesia with normal nerve conduction studies. Skin biopsy specimen showed decreased intraepidermal nerve fiber density, indicating small-fiber neuropathy. Besides, clinical symptoms, duodenal biopsy, and positive HLA-DQ2 and -DQ8 suggested celiac disease, which might be associated with small-fiber neuropathy. Intravenous immunoglobulin was not efficacious. Celiac disease should be considered in the evaluation of peripheral neuropathy.