Gluten psychosis: A case report and review of literature

Objectives: A singular report of non-celiac gluten sensitivity (NCGS) presenting with hallucinations has been described in an adult patient. We report the first pediatric case of a psychotic disorder clearly related toNCGS and investigate the causes by a review of literature. Case report: A 12 year-old girl reported daily headache, and behavior alterations. One month after, she began to have complex hallucinations. Screening for infectious, metabolic, autoimmune, and neurologic diseases resulted negative. A psychotic disorder wasdiagnosed. Treatmentwitha second-generationanti-psychotic was started but psychotic symptoms persisted. After 2 years, due to gastro-intestinal complaints, a nutritionist was consulted, and a gluten-free diet (GFD) was recommended; within a week both gastro-intestinal and psychiatric symptoms dramatically improved. After 5 months she was admitted to our outpatient. We performed a double-blind challenge test with wheat and rice flour. During the administration of rice flour, symptoms were absent. During the second day of wheat flour intake, the girl presented headache, halitosis, abdominal distension, mood disorders, and three episodes of severe hallucinations. After the challenge she tested negative for: CD serology, food specific-IgE, skin prick test to wheat, atopy patch test to wheat, duodenal biopsy. A GFD was started with a complete regression of all symptoms. Nine months after she is still symptoms-free. Conclusions: The present case-report confirms that psychosis may be a manifestation of NCGS, and may involve also children. Well-designed prospective studies are needed to establish the real role of gluten as a triggering factor in neuro-psychiatric disorders.