The first Japanese case of biopsy‐confirmed small‐fiber neuropathy related to celiac disease

A 26‐year‐old lady presented with a rapidly progressive burning pain in both feet. She had been bothered by bloating after wheat‐containing foods since the age of 21. Her gastrointestinal symptoms alleviated after introducing gluten‐free diet. On admission, neurological examination was unremarkable without dysesthesia with normal nerve conduction studies. Skin biopsy specimen showed decreased intraepidermal nerve fiber density, indicating small‐fiber neuropathy. Besides, clinical symptoms, duodenal biopsy, and positive HLA‐DQ2 and ‐DQ8 suggested celiac disease, which might be associated with small‐fiber neuropathy. Intravenous immunoglobulin was not efficacious. Celiac disease should be considered in the evaluation of peripheral neuropathy.