Osteomalacic myopathy associated with coexisting coeliac disease and primary biliary cirrhosis.

OBJECTIVE To report a patient with coeliac disease (CD) associated with primary biliary cirrhosis (PBC) who presented with myopathy without classical symptoms of CD. CLINICAL PRESENTATION AND INTERVENTION A 42-year-old woman presented with inability to walk and marked loss of motor function. She had elevated liver enzymes with a cholestatic pattern. Antimitochondrial antibody M2 band, anti-endomysial antibody, antigliadin IgA and IgM were positive. Histopathologic findings of the liver revealed PBC and duodenal biopsy was consistent with CD. She was also found to have osteomalacia. She showed slow response to gluten-free diet, but accelerated full recovery with vitamin D replacement. CONCLUSION In PBC patients with subclinical CD and myopathy, vitamin D status can provide a basis for treatment.