Tanya Amal, MBBS1, Aleena Sharif, MBBS2, Tanveer Ahmed, MD, MBBS3, Husnain Ahmad, MBBS4, Mubeen Qayyum, MBBS3, Shabaz Ahmad Qureshi, MBBS3 1Corewell Health, Royal Oak, MI; 2Sheikh Zayed Medical College Raheem Yar Khan, Bahawalpur, Punjab, Pakistan; 3Bahawal Victoria Hospital, Bahawalpur, Bahawalpur, Punjab, Pakistan; 4Shalamar Institute of Health Sciences, Lahore, Punjab, Pakistan Introduction: Neuropsychiatric manifestations are a rare but recognized complication of celiac disease/gluten sensitivity, occurring in up to 22% of patients: ranging from epilepsy, cerebellar ataxia, peripheral neuropathy, schizophrenia, anxiety, ADHD, to depression. The proposed pathomechanism involves cross-reactivity to neural antigens, observed in about 42% of patients. Cross-reactivity to anti-ganglioside antibodies has been documented in patients with cerebellar ataxia and peripheral neuropathy. Schizophrenia, in particular, has strong evidence in case reports where a gluten-free diet led to earlier symptom relief (Dohan et al.). Conversely, gluten reintroduction led to symptom worsening (Singh et al.).
Case Description/
Methods: A 25-year-old male presented with 6 months of fatigue, 6 kg weight loss, early satiety, and intermittent nausea. He also reported persecutory delusions, visual hallucinations, disorganized thinking, and mood disturbances. Multiple psychiatric evaluations failed to yield a DSM-5 diagnosis, and medications offered minimal relief.
On exam, he had conjunctival pallor, muscle wasting, and a BMI of 17.2 kg/m². He showed food aversion, particularly to wheat. There was no family history of celiac disease or eating disorders.
Labs revealed microcytic hypochromic anemia (Hb 9.0 g/dL) and albumin of 3.5 g/dL. Celiac serology was positive for anti-tTG IgA and IgG. Endoscopy showed scalloping and fissuring of duodenal folds. Duodenal biopsies confirmed celiac disease (Marsh III) with villous atrophy, crypt hyperplasia, and increased intraepithelial lymphocytes.
A strict gluten-free diet (GFD) led to marked improvement in psychiatric symptoms within two weeks. Delusions and hallucinations resolved entirely within a month, mood stabilized, and psychotropic medications were discontinued. Nutritional rehabilitation improved appetite, corrected anemia, and increased BMI to 21.4. The patient remains symptom-free on follow-up while continuing a GFD. Discussion: This case highlights the neuropsychiatric spectrum of celiac disease, which may precede or overshadow gastrointestinal symptoms. Gluten may trigger immune-mediated neuroinflammation or malabsorption, leading to mood disorders or psychosis.Guidelines recommend considering celiac disease in unexplained neuropsychiatric cases, especially with nutritional deficiencies. Early diagnosis prevents complications
Disclosures: Tanya Amal indicated no relevant financial relationships. Aleena Sharif indicated no relevant financial relationships. Tanveer Ahmed indicated no relevant financial relationships. Husnain Ahmad indicated no relevant financial relationships. Mubeen Qayyum indicated no relevant financial relationships. Shabaz Ahmad Qureshi indicated no relevant financial relationships.
Tanya Amal, MBBS1, Aleena Sharif, MBBS2, Tanveer Ahmed, MD, MBBS3, Husnain Ahmad, MBBS4, Mubeen Qayyum, MBBS3, Shabaz Ahmad Qureshi, MBBS3. P4113 - Beyond the Gut: Psychosis as an Early Manifestation of Celiac Disease, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
