Abstract
A 37-year-old woman presented with back pain, diffuse musculoskeletal pain, and muscle weakness without marked gastrointestinal symptoms. She complained of difficulty in walking and bilateral hip pain for the preceding year. Clinical examination revealed proximal muscle weakness especially in the lower extremities and a waddling gait pattern. Laboratory parameters and radiographic findings revealed the diagnosis of osteomalacia. The etiology of osteomalacia was investigated and a diagnosis of celiac disease was established. As osteomalacia symptoms may be the only presenting feature of celiac disease, it should be considered in the differential diagnosis of patients presenting with proximal muscle weakness and diffuse musculoskeletal pain.
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References
Dieterich W, Esslinger B, Schuppan D (2003) Pathomechanisms in celiac disease (abstract). Int Arch Allergy Immunol 132:98–108
Jewell DP (2003) Coeliac disease. In: Warrell DA, Cox TM, Firth JD, Benz EJ (eds) Oxford Textbook of Medicine. Oxford University Press, New York, pp 585–589
Schuppan D (2000) Current concepts of celiac disease pathogenesis. Gastroenterology 119:234–242
Byrne MF, Razak AR, Leader MB, Sheehan KM, Patchett SE (2002) Disabling osteomalacic myopathy as the only presenting feature of coeliac disease. Eur J Gastroenterol Hepatol 14:1271–1274
Moss AJ, Waterhouse C, Terry R (1965) Gluten-sensitive enteropathy with osteomalacia but without steatorrhea. N Engl J Med 272:825–830
De Boer WA, Tytgat GN (1992) A patient with osteomalacia as a single presenting symptom of gluten sensitive enteropathy. J Intern Med 232:81–85
Basu RA, Elmer K, Babu A, Kelly CA (2000) Coeliac disease can still present with osteomalacia. Rheumatology 39:335–336
Jawad AS, Squire SB, Perry JD (1988) Osteomalacia and coeliac disease presenting as isolated dactylitis. Ann Rheum Dis 47:692–694
Hajjar ET, Vincenti F, Salti IS (1974) Gluten induced enteropathy: osteomalacia as its principal manifestation. Arch Intern Med 134:565–566
Wong M, Scally J, Watson K, Best J (2002) Proximal myopathy and bone pain as the presenting features of coeliac disease. Ann Rheum Dis 61:87
Garcia-Porrua C, Gonzales-Gay MA, Avila-Alvarenga S, Rivas MJ, Soilan J, Penedo M (2000) Coeliac disease and osteomalacia: an association still present in Western countries. Rheumatology 39:1435
Hin H, Bird G, Fisher P, Mahy N, Jewell D (1999) Coeliac disease in primary care: case finding study. BMJ 318:164–167
Hardoff D, Sharf B, Berger A (1980) Myopathy as a presentation of coeliac disease (abstract). Dev Med Child Neurol 22:781–783
Cimaz R, Bazzi P, Prelle A (2000) Myopathy associated with rickets and celiac disease. Acta Paediatr 89:496–497
Jain V, Angitii RR, Singh S, Thape BR, Kumar L (2002) Proximal muscle weakness—an unusual presentation of coeliac disease. J Trop Pediatr 48:380–381
McFarlane XA, Bhalla AK, Robertson DAF (1996) Effect of a gluten free diet on osteopenia in adults with newly diagnosed coeliac disease. Gut 39:180–184
Unsworth DJ (1996) Serological diagnosis of gluten sensitive enteropathy. J Clin Pathol 49:704–707
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Kozanoglu, E., Basaran, S. & Goncu, M.K. Proximal myopathy as an unusual presenting feature of celiac disease. Clin Rheumatol 24, 76–78 (2005). https://doi.org/10.1007/s10067-004-0977-5
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DOI: https://doi.org/10.1007/s10067-004-0977-5