Article citationsMore >>

Ludvigsson JF, Bai JC, Biagi F et al ; BSG Coeliac Disease Guidelines Development Group; British Society of Gastroenterology. Diagnosis and management of adult celiac disease: guidelines from the British Society of Gastroenterology. Gut. 2014; 63: 1210-28.

has been cited by the following article:

Article

Celiac Disease Presenting as Cardiomyopathy - A Rare Extra Intestinal Manifestation

1Department of Gastroenterology, Apollo Hospitals International Limited, Ahmedabad, India


International Journal of Celiac Disease. 2020, Vol. 8 No. 2, 56-57
DOI: 10.12691/ijcd-8-2-4
Copyright © 2020 Science and Education Publishing

Cite this paper:
Shravan Bohra, Apurva Shah. Celiac Disease Presenting as Cardiomyopathy - A Rare Extra Intestinal Manifestation. International Journal of Celiac Disease. 2020; 8(2):56-57. doi: 10.12691/ijcd-8-2-4.

Correspondence to: Apurva  Shah, Department of Gastroenterology, Apollo Hospitals International Limited, Ahmedabad, India. Email: apurvashah411@gmail.com

Abstract

Cardiac manifestations of celiac disease has been poorly described in literature though some studies have emphasized on correlation of ischemic heart disease, atrial fibrillation and dilated cardiomyopathy with celiac disease. We describe a patient with celiac disease associated cardiomyopathy whose cardiac function improved substantially after treatment with a gluten-free diet. A young lady of 35 years age was admitted with complaints of chronic diarrhea, vomiting, significant weight loss, dizziness and chronic iron deficiency anemia since last 3 months. Physical examination revealed tachycardia, tachypnoea and hypotension requiring multiple high dose inotropic support. She had pallor, skin changes and pedal edema suggestive of malabsorption. Investigations revealed iron deficiency anemia, high bilirubin and transaminases, prothrombin time, low albumin and elevated tissue trasglutaminase antibody. Echocardiography showed global hypokinesia with a left ventricular ejection fraction of 20%. Diagnosis of celiac disease made on clinic features, serology and biopsy finding of subtotal villous atrophy, crypt hyperplasia, and increased intraepithelial lymphocytes. She was kept on gluten free diet and on intravenous steroids for acute celiac crises and celiac related cardiomyopathy as patient had severe diarrhea, hypocalcaemia, weight loss, hypoproteinemia and hypotension. Patient improved within 48 hours of steroid with discontinuation of inotropes. She was discharged with gluten free diet and follow up after 6 months showed near normalization of all biochemical abnormalities and ejection fraction of 55%. Cardiomyopathy associated with celiac disease and celiac crisis is a serious and potentially lethal condition. However, with early diagnosis and treatment with a gluten free diet, and steroids cardiomyopathy in patients with celiac disease may be completely reversible.

Keywords