Dilated cardiomiopathy associated with celiac disease: Case report and literature review

Introduction. Celiac disease is an inflammatory condition of the small intestinal mucosa induced by gluten consumption in genetically susceptible individuals, leading to a spectrum of gastrointestinal presentation. A number of autoimmune and other disorders are highly associated with celiac disease. Cardiomyopathy associated with celiac disease has been rarely reported in the literature. Case Outline. We present a case of a 27-year-old male with one month history of diarrhea, weight loss, fatigue, dyspeptic symptoms, peripheral edema, and cardiac palpitations. After positive serological screening with immunoglobulin A anti-tissue transglutaminase antibody test, the diagnosis of celiac disease was confirmed with histopathology examination of duodenal biopsy specimen. Echocardiographic findings were consistent with acute myocarditis. After common causes of myocarditis had been excluded, probable celiac disease-associated autoimmune myocarditis was diagnosed. The patient was recommended to undergo a strict life-long gluten-free diet. IgA anti-transglutaminase antibodies, and anti-gliadin antibodies, were both significantly elevated during the 6-, 12- and 18-month follow-up. Low compliance to gluten-free diet in our patient led to progressive worsening of the left ventricular ejective fraction and other serious cardiac complications which warranted invasive cardiac interventions. Conclusion. Dilated cardiomyopathy associated with celiac disease is a serious condition which requires multidisciplinary approach involving gastroenterologist and cardiologist. Compliance with gluten-free diet is mandatory if patients are to avoid progression of cardiomyopathy. Screening of patients with idiopathic dilated cardiomyopathy for celiac disease is advisable. Uvod. Celijacna bolest je zapaljenjsko oboljenje mukoze tankog creva izazvano ingestijom glutena kod genetski predodredjenih osoba koje vodi ka nizu gastrointestinalnih manifestacija. Mnoge autoimunske bolesti, kao i druga oboljenja, visoko znacajno su udruzena s celijacnom bolescu. O kardiomiopatiji udruzenoj s celijacnom bolescu se retko pisalo u literaturi. Prikaz bolesnika. Prikazujemo slucaj 27-godisnjeg muskarca s jednomesecnom istorijom dijareje, gubitka telesne mase, malaksalosti, dispepticnih tegoba, perifernih edema i palpitacija. Nakon pozitivnog seroloskog skrininga s imunoglobulin A antitransglutaminskim antitelima, dijagnoza celijacne bolesti je potvrdjena histopatoloskim pregledom preparata biopsije duo