Objective: To report a case of celiac disease in Parkinson’s disease and CIPD, and examine the relationship.

Background: Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP) is a chronic, symmetric sensorimotor neuropathy, thought to involve immune mediated insult to the myelin sheath, and may be associated with infection, malignancy, and autoimmunity. Parkinson’s disease (PD) has been theorized to involve autoimmune etiologies as well; recent studies have pointed to common genetic pathways between PD and autoimmune diseases including not only Crohn’s Disease, ulcerative colitis and rheumatoid arthritis, but also Celiac’s Disease.

Method: Case study of a 69 year old man with history of undifferentiated connective tissue disease diagnosed at age 51 (clinical dermatomyositis with positive antinuclear antibody and anti-Smith antibody) and onset of gait predominant Parkinson’s disease at age 67. PD onset was characterized by shuffling gait and handwriting difficulties and responded to low dose levodopa therapy.

Results: Two years after onset of PD, there was progressive bilateral leg weakness, imbalance and parasthesias. EMG was suggestive of CIDP, and IVIG led to symptomatic improvement. Evaluation demonstrated elevated gliadin and tissue transglutaminase antibodies; jejunal biopsy confirmed celiac disease. Gluten-free diet normalized his celiac antibody levels. He achieved near total remission (residual mild distal numbness) after tapering off IVIG and continuing a gluten-free diet. His PD symptoms remained stable on carbidopa-levodopa and rasagiline, with slow progression and development of dyskinesias.

Conclusion: We present a case of Parkinson’s disease and multiple autoimmune disorders who developed CIDP, likely secondary to celiac’s disease, which resolved with IVIG and strict gluten-free diet. This case highlights the possible role of auto- or dysimmunity in the pathogenesis of PD, although also suggests that immune-targeted treatment may not affect PD symptoms or progression.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/parkinsons-disease-and-chronic-inflammatory-demyelinating-polyneuropathy-with-celiac-disease-improvement-in-neuropathy-but-not-parkinsons-symptoms-after-intravenous-immunoglobulin-and-gluten-free/