Osteomalacic Myopathy Associated with Coexisting Coeliac Disease and Primary Biliary Cirrhosis

Abstract

Objective: To report a patient with coeliac disease (CD) associated with primary biliary cirrhosis (PBC) who presented with myopathy without classical symptoms of CD. Clinical Presentation and Intervention: A 42-year-old woman presented with inability to walk and marked loss of motor function. She had elevated liver enzymes with a cholestatic pattern. Antimitochondrial antibody M2 band, anti-endomysial antibody, antigliadin IgA and IgM were positive. Histopathologic findings of the liver revealed PBC and duodenal biopsy was consistent with CD. She was also found to have osteomalacia. She showed slow response to gluten-free diet, but accelerated full recovery with vitamin D replacement. Conclusion: In PBC patients with subclinical CD and myopathy, vitamin D status can provide a basis for treatment.

Vitamin D deficiency in patients with intestinal malabsorption syndromes – think in and outside the gut

“…A significant number of patients with intestinal malabsorption syndromes, including celiac disease (CD), cystic fibrosis (CF), short bowel syndrome, inflammatory bowel disease (IBD) and intestinal accessory organ dysfunction, present with vitamin D deficiency or insufficiency (Table ) . Not surprisingly, many of these vitamin D‐deficient patients have bone metabolism disorders and decreased bone mineral density . Interestingly, although patients with severe CF may present with vitamin D deficiency, they as a group appear to experience mostly borderline vitamin D deficiency …”

Osteomalacic myopathy: A re-emerging scourge hiding in plain sight

“…Common causes include malnutrition, prolonged use of anticonvulsant medication, 3 and malabsorption due to coeliac disease 4 and primary biliary cirrhosis. 5 Early recognition requires a low threshold of awareness and is crucial to avoid a prolonged diagnostic odyssey including invasive testing such as electromyography (EMG) in these patients.…”