Chorea: An Atypical Manifestation of Coeliac Disease

Chorea is a rare neurological manifestation of coeliac disease. A 35-year-old male presented with a nine month history of chorea, starting from the right little finger and spreading over the next few months to involve the right upper and lower limbs. History and physical examination were not suggestive of an underlying cause. CT scan and MRI scan did not reveal any structural abnormality. Levels of serum IgA anti-tissue transglutaminase antibodies were very very high (396EU/ml). Duodenoscopy and duodenal histology were normal. Marked symptomatic improvement was seen with gluten free diet, along with disappearance of anti-tissue transglutaminase antibodies. Chorea can occur as an atypical manifestation of coeliac disease. This possibility must be kept in mind when the cause of chorea is not easily identifiable.