DOI: https://doi.org/10.36347/sjmcr.2026.v14i06.045

Pages: 1503-1505

Background: Celiac disease is a chronic autoimmune enteropathy triggered by gluten exposure in genetically predisposed individuals. Although gastrointestinal manifestations are classically predominant, atypical and extraintestinal presentations are increasingly recognized. Neurological and psychiatric manifestations may occasionally represent the sole presenting features, leading to diagnostic delays. Case Presentation: We report the case of a 56-year-old man with no significant medical history who presented with progressive neuropsychiatric symptoms over a four-month period, including behavioral changes, aggressiveness, psychomotor agitation, incoherent speech, and memory impairment. Physical examination revealed no focal neurological deficits or gastrointestinal symptoms. Brain magnetic resonance imaging showed diffuse cortico-subcortical atrophy, while cerebrospinal fluid analysis and electroencephalography were unremarkable. Laboratory investigations revealed iron-deficiency anemia suggestive of malabsorption. Serological testing demonstrated strongly positive anti-tissue transglutaminase IgA antibodies. Upper gastrointestinal endoscopy showed a pseudonodular duodenal mucosa, and histopathological examination of duodenal biopsies revealed total villous atrophy classified as Marsh 3c. A diagnosis of celiac disease was established. The patient was started on a strict gluten-free diet with nutritional and neurological follow-up, resulting in favorable clinical improvement. Conclusion: This case highlights an unusual presentation of celiac disease revealed exclusively by neuropsychiatric manifestations in the absence of digestive symptoms. It underscores the importance of considering celiac disease in the differential diagnosis of unexplained behavioral and cognitive disorders, particularly when associated with iron-deficiency anemia or other signs suggestive of malabsorption. Early diagnosis and treatment may improve clinical outcomes and prevent long-term neurolog