Severe Dilated Cardiomyopathy in a Girl with Celiac Disease and Type 1 Diabetes

Abstract

An 18-year-old girl was admitted for tachycardia and dyspnea of effort stage II of NYHA. Her medical history revealed a stroke four months ago and uncontrolled type 1 diabetes since the age of 10 years. Physical examination showed a short stature, pallor, muscular atrophy and delayed puberty but no diabetic neuropathy. Direct inquiry revealed that she has had clinical signs of classical celiac disease since the early infancy and secondary amenorrhea since two years. Ophtalmological examination did not show diabetic retinopathy. Echocardiography revealed the presence of a big thrombus, hypokinesis and dilated cardiomyopathy with a low rate of left ventricular ejection fraction at 20%. Laboratory tests yielded a high level of B-type natriuretic peptide, anemia, vitamin D deficiency, hypocholesterolemia and low level of high density lipoprotein. Microalbuminuria was negative. All serological markers of celiac disease were highly positive. The patient was put on gluten free diet and she received a resynchronization cardiac therapy. We emphasize that celiac disease and type 1 diabetes must be kept in mind in etiological diagnosis of dilated cardiomyopathy.