Abstract
Clinical features and pathological findings of sural nerve biopsy are reported of
a 3-year-old child affected with coeliac disease who developed a progressive polyneuropathy,
unresponsive to a gluten-free diet, nor to vitamin E and folic acid supply. There
was no evidence of malabsorption, nor of blood factor deficiency, nor of metabolic
abnormalities which might account for the neuropathy. A sural nerve biopsy showed
marked loss of myelinated fibres without evidence of regenerative phenomena. Distal
involvement and features of nerve pathology are consistent with a "dying-back" mechanism
to underlie the nerve damage. The lack of response to a gluten-free diet suggests
that direct toxicity of gliadin is not implicated.
Key words
Coeliac disease - Peripheral neuropathy - Nerve biopsy
