Transverse myelitis (TM) can be a devastating illness in which a spinal level injury occurs with partial to complete loss of neurological function below the affected spinal level. It is seen most often in patients with underlying autoimmune disease and/or following infection as a presumed triggered of an autoimmune response, but it is also seen more rarely in previously well children. Treatment is with immune suppression, usually high dose corticosteroids, which may or may not reverse the spinal injury. Krom and colleagues (10.1542/peds.2016-1381) writing from Emma Children’s Hospital in the Netherlands bring to our attention the unusual pairing of celiac disease (CD) and TM. This appears to have been the first reported association of these two conditions in pediatrics (only one other similarly associated patient pathology was in an adult). The authors allow for the possibility that the clinical presentation was a curious coincidence of a rare condition (TM) and an infrequent condition (CD) in the same patient. Treatment with high dose corticosteroids and gluten free diet was associated with complete neurological recovery.
Celiac disease has been associated on occasion with other neurological features including peripheral neuropathy, optic neuritis, encephalopathy, brain infarction demyelinating lesions and other white matter injury. Speculation has been offered that these neurologic complications occur because of autoimmunity induced by CD and perhaps directly due to a secondary vasculitis. Krom et al have provided a starting point for hypothesis testing research. Obtaining celiac laboratory assessment on children presenting with TM without an apparent cause may clarify if this is or is not a remarkably unfortunate coincidence.