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