International Journal of Celiac Disease
ISSN (Print): 2334-3427 ISSN (Online): 2334-3486 Website: Editor-in-chief: Samasca Gabriel
Open Access
Journal Browser
International Journal of Celiac Disease. 2019, 7(2), 53-55
DOI: 10.12691/ijcd-7-2-5
Open AccessArticle

Sprue-Like Intestinal Disease Complicated by Inclusion Body Myositis

Hugh J. Freeman1,

1Department of Medicine (Gastoenterology), University of British Columbia, Vancouver, British Columbia, Canada

Pub. Date: August 13, 2019

Cite this paper:
Hugh J. Freeman. Sprue-Like Intestinal Disease Complicated by Inclusion Body Myositis. International Journal of Celiac Disease. 2019; 7(2):53-55. doi: 10.12691/ijcd-7-2-5


A woman with long-standing weight loss and malabsorption demonstrated a severe sprue-like enteropathy. She insidiously developed persistent and progressive muscle weakness caused by inclusion body myositis, an uncommon muscle disorder. Treatment with a gluten-free diet, steroids, calcium, zinc and vitamin supplements, including empirical vitamin E resulted in weight gain, but failed to histologically improve her small intestinal mucosa or the muscle weakness which became profound. The myopathic process could reflect a co-existent autoimmune disorder, or, possibly a direct result of long-standing and superimposed nutrient deficits. An alternative explanation may be a hitherto unrecognized syndrome manifested as inclusion body myositis and a form of sprue-like enteropathy.

celiac disease gluten enteropathy small bowel ulcer non-granulomatous ulcerative jejunitis myopathy inclusion body myositis

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit


[1]  Gujral N, Freeman HJ, Thomson AB. Celiac disease: prevalence, diagnosis, pathogenesis and treatment. World J Gastroenterol 2012; 18: 6036-6059.
[2]  Freeman HJ. Chapter 34. Celiac Disease. In: Encyclopedia of Human Biology, 3rd Edition, Oxford, Ed. Simon MI, Abelson S, 2014.
[3]  Freeman HJ. Sprue-like intestinal disease. Int J Celiac Dis 2014; 2: 6-10.
[4]  Muller AF, Donnelly MT, Smith CM, Grundman MJ, Holmes GK, Toghill PJ. Neurological complications of celiac disease: a rare but continuing problem. Am J Gastroenterol 1996; 91: 1430-1435.
[5]  Freeman HJ. Neurological disorders with celiac disease. Can J Gastroenterol 2008; 22: 909-911.
[6]  Nanji A, Freeman HJ, Anderson FH. Paralysis and rehabdomyolysis: a presenting feature of celiac disease. West J Med 1982; 136: 272-274.
[7]  Meini A, Morandi L, Mora M, Bernasconi P, Monaco V, Pillan MN, Ugazio AG, Plebani A. An unusual association: celiac disease and Becker muscular dystrophy. Am J Gastroenterol 1996; 91: 1459-1460.
[8]  Ebert EC. Review article: the gastrointestinal complications of myositis. Aliment Pharmacol There 2010; 31: 359-365.
[9]  Hadjivassiliou M, Chattopadhyay AK, Davies-Jones GA, Gibson A, Grunewald RA, Lobo AJ. Neuromuscular disorder as a presenting feature of celiac disease. J Neurol Neurosurg Psychiatry 1997; 63: 770-775.
[10]  Danon MJ, Reyes MG, Perurena OH, Masdeu JC, Manaligod JR. Inclusion body myositis. A corticosteroid-resistant idiopathic inflammatory myopathy. Arch Neurol 1982; 39: 760-764.
[11]  Marie I, Lecomte F, Hachulla E, Antonietti M, Francois A, Levesque H, Courtois H. An uncommon association: celiac disease and dermatomyositis in adults. Clin Exp Rheumatol 2001; 19: 201-203.
[12]  Kleopa KA, Kyriacou K, Zamba-Papanicolaou E, Kyriakides T. Reversible inflammatory and vacuolar myopathy with vitamin E deficiency in celiac disease. Muscle Nerve 2005; 31: 260-265.
[13]  Freeman HJ. Mucosal recovery and mucosal healing in biopsy-defined adult celiac disease. International J Celiac Dis 2017; 5: 14-18.
[14]  Freeman HJ. Refractory celiac disease and sprue-like intestinal disease. World J Gastroenterol 2008; 14: 828-830.
[15]  Freeman HJ. Drug-induced sprue-like intestinal disease. International J Celiac Dis 2014; 2: 49-53.
[16]  Chad D, Good P, Edelman L, Bradley WG, Mills J. Inclusion body myositis association with Sjogren’s syndrome. Arch Neurol 1982; 39: 186-188.
[17]  Gutmann L, Govindan S, Riggs JE, Schochet SS Jr. Inclusion body myositis and Sjogren’s syndrome. Arch Neurol 1985; 42: 1021-1022.
[18]  Danon MJ, Perurena OH, Ronan S, Manaligod JR. Inclusion body myositis associated with systemic sarcoidosis. Can J Neurol Sci 1986; 13: 334-336.
[19]  Briani C, Doria A, Sarzi-Puttini P, Dalakas MC. Update on idiopathic inflammatory myo-Patties. Autoimmunity 2006; 39: 161-170.