Reference: Battisti C, Dotti MT, Formichi P, et al. Disappearance of skin lipofuscin storage and marked clinical improvement in adult onset coeliac disease and severe vitamin E deficiency after chronic vitamin E megatherapy. J Submicrosc Cytol Pathol 1996; 28:339-44.

Summary: This paper presents the case of a 56 year old man who developed diarrhea, steatorrhea, paresthesias and tremor over six months' time. He had undetectable serum levels of vitamin E, severe serum folic acid and IgA deficiency, elevated levels of C-reactive protein, and other nonspecific markers of inflammation, hypocholesterolemia and iron-deficiency anemia. A skin biopsy revealed accumulation of the oxidation product lipofuscin. Celiac disease was diagnosed by jejunal biopsy. A gluten-free diet and 900 mg of vitamin E daily (first intravenously, then intramuscularly, then orally) led to significant improvement in his symptoms and clinical laboratory findings after more than a year. A repeat skin biopsy showed elimination of lipofuscin accumulation.

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