Case Reports in Gastrointestinal Medicine seems to be associated, but not cosegregated, with dilated cardiomyopathy in familial cases [22]. Interestingly, celiac disease is associated with a decrease in ischemic heart disease [23]. Compared to a normal population, patients with celiac disease have lower cholesterol, lower triglycerides, lower apo- lipoprotein B, lower ﬁbrinogen, and higher HDL [24]. Our patient was typed for HLA DQ B1∗02,∗03 DRB1∗03∗04. In some reports we found that in DMC there is a greater incidence of B15 (20 versus 6%) and DQ3 (83 versus 50%) antigens [25]. Our case highlights several important points about celiac disease and associated conditions. Celiac disease in child- hood can be asymptomatic or presents with extremely few symptoms. Cardiomyopathy associated with celiac disease is a serious and potentially lethal condition. It is very rare espe- cially in early childhood, but still present. All the pediatric patients who present with DMC or myocarditis in the absence of known etiologies should be carfully investigated. The discovery of celiac disease associated with a DMC of nondetermined etiology raises the question of mechanism of this association in the goal of new therapeutic option. References [1] M. Ma¨ki, K. Mustalahti, J. Kokkonen et al., “Prevalence of celiac disease among children in Finland,” The New England Journal of Medicine, vol. 348, no. 25, pp. 2517–2524, 2003. [2] A. Meini, N. M. Pillan, V. Villanacci, V. Monafo, A. G. Ugazio, and A. Plebani, “Prevalence and diagnosis of celiac disease in IgA-deﬁcient children,” Annals of Allergy, Asthma and Immunology, vol. 77, no. 4, pp. 333–336, 1996. [3] C. E. Counsell, A. Taha, and W. S. J. Ruddell, “Coeliac disease and autoimmune thyroid disease,” Gut, vol. 35, no. 6, pp. 844– 846, 1994. [4] C. C. Cronin, A. Feighery, J. B. Ferriss, C. Liddy, F. Shanahan, and C. Feighery, “High prevalence of celiac disease among pa- tients with insulin-dependent (type I) diabetes mellitus,” The American Journal of Gastroenterology, vol. 92, no. 12, pp. 2210– 2212, 1997. [5] A. H. Talal, J. A. Murray, J. A. Goeken et al., “Celiac disease in an adult population with insulin-dependent diabetes mellitus: use of endomysial antibody testing,” The American Journal of Gastroenterology, vol. 92, no. 8, pp. 1280–1284, 1997. [6] R. J. Farrell and C. P. Kelly, “Celiac sprue,” The New England Journal of Medicine, vol. 346, no. 3, pp. 180–188, 2002. [7] A. K. Rustgi and M. A. Peppercorn, “Gluten-sensitive entero- pathy and systemic lupus erythematosus,” Archives of Internal Medicine, vol. 148, no. 7, pp. 1583–1584, 1988. [8] G. R. Komatireddy, J. B. Marshall, R. Aqel, L. E. Spollen, and G. C. Sharp, “Association of systemic lupus erythematosus and gluten enteropathy,” Southern Medical Journal, vol. 88, no. 6, pp. 673–676, 1995. [9] P. Collin, T. Reunala, E. Pukkala, P. Laippala, O. Keyrilainen, and A. Pasternack, “Coeliac disease—associated disorders and survival,” Gut, vol. 35, no. 9, pp. 1215–1218, 1994. [10] A. Frustaci, L. Cuoco, C. Chimenti et al., “Celiac disease asso- ciated with autoimmune myocarditis,” Circulation, vol. 105, no. 22, pp. 2611–2618, 2002. [11] M. Curione, M. Barbato, L. De Biase, F. Viola, L. Lo Russo, and E. Cardi, “Prevalence of coeliac disease in idiopathic dilated cardiomyopathy,” The Lancet, vol. 354, no. 9174, pp. 222–223, 1999. 3 [12] D. Prati, M. T. Bardella, M. Peracchi, L. Porretti, M. Scalam- ogna, and D. Conte, “Antiendomysial antibodies in patients with end-stage heart failure,” The American Journal of Gastro- enterology, vol. 97, no. 1, pp. 218–219, 2002. [13] G. Gasbarrini, R. Ciccocioppo, I. De Vitis, G. R. Corazza, and Club del Tenue Study Group, “Coeliac disease in the elderly. A multicentre Italian study,” Gerontology, vol. 47, no. 6, pp. 306– 310, 2001. [14] J. P. Barrio, G. Cura, G. Ramallo et al., “Heart transplantation in rapidly progressive end-stage heart failure associated with celiac disease,” BMJ Case Reports, vol. 2011, 2011. [15] M. Dogˇan, E. Peker, E. Cagan et al., “Stroke and dilated cardi- omyopathy associated with celiac disease,” World Journal of Gastroenterology, vol. 16, no. 18, pp. 2302–2304, 2010. [16] M. Curione, M. Barbato, F. Viola, P. Francia, L. De Biase, and S. Cucchiara, “Idiopathic dilated cardiomyopathy associated with coeliac disease: the eﬀect of a gluten-free diet on cardiac performance,” Digestive and Liver Disease, vol. 34, no. 12, pp. 866–869, 2002. [17] R. Lakhhdar, H. Ben Slima, M. Drissa, and H. Drissa, “Family dilated cardiomyopathy associated to celiac disease,” La Tunisie Medicale, vol. 90, no. 2, pp. 181–183, 2012. [18] M. Curione, C. Danese, F. Viola et al., “Carnitine deﬁciency in patients with coeliac disease and idiopathic dilated cardiomy- opathy,” Nutrition, Metabolism and Cardiovascular Diseases, vol. 15, no. 4, pp. 279–283, 2005. [19] N. Uslu, H. Demir, T. Karago¨z, and I. N. Saltik-Temizel, “Dilated cardiomyopathy in celiac disease: role of carnitine deﬁciency,” Acta Gastro-Enterologica Belgica, vol. 73, no. 4, pp. 530–531, 2010. [20] R. M. van Elburg, J. J. Uil, C. J. J. Mulder, and H. S. A. Heymans, “Intestinal permeability in patients with coeliac disease and relatives of patients with coeliac disease,” Gut, vol. 34, no. 3, pp. 354–357, 1993. [21] B. Chuaqui, J. Garrido, and P. Casanegra, “Actin-deﬁcient cardiomyopathy coexisting with celiac disease:a chance asso- ciation?” Pathology Research and Practice, vol. 181, no. 5, pp. 604–614, 1986. [22] T. Not, E. Faleschini, A. Tommasini et al., “Celiac disease in patients with sporadic and inherited cardiomyopathies and in their relatives,” European Heart Journal, vol. 24, no. 15, pp. 1455–1461, 2003. [23] P. J. Whorwell, M. R. Alderson, K. J. Foster et al., “Death from ischaemic heart-disease and malignancy in adult patients with coeliac disease,” The Lancet, vol. 2, no. 7977, pp. 113–114, 1976. [24] J. T. Lear, R. H. Neary, P. Jones, D. A. Fitzgerald, and J. S. C. English, “Risk factors for ischaemic heart disease in patients with dermatitis herpetiformis,” Journal of the Royal Society of Medicine, vol. 90, no. 5, pp. 247–249, 1997. [25] A. Osa, L. Almenar, M. Palencia, N. Puig et al., “Antigens of the major histocompatibility system in ischemic heart disease and idiopathic dilated cardiomyopathy,” Clinical Cardiology, vol. 22, no. 4, pp. 292–296, 1999.