Hindawi Publishing Corporation Case Reports in Gastrointestinal Medicine Volume 2012, Article ID 170760, 3 pages doi:10.1155/2012/170760 Case Report Cardiomyopathy Associated with Celiac Disease in Childhood Aleksandra Boskovic, Ivana Kitic, Dragan Prokic, and Ivica Stankovic Department of Gastroenterology and Hepatology, Mother and Child Health Care Institute, Radoja Dakica 4-6, Belgrade 11070, Serbia Correspondence should be addressed to Aleksandra Boskovic, aleksandra.bos@hotmail.com Received 9 August 2012; Accepted 20 September 2012 Academic Editors: H. Akiho, T. Hirata, F. H. Mourad, and H. Sugimura Copyright © 2012 Aleksandra Boskovic et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Celiac disease is predominantly a disease of the small intestine characterized by chronic malabsorption in genetically susceptible individuals who ingest grains containing gluten, such as wheat, barley, and rye. Although previously believed to be uncommon, celiac disease may be present in up to 1% of the adult and children population. Celiac disease is associated frequently with iron- deﬁciency anemia, dermatitis herpetiformis, selective IgA deﬁciency, thyroid disorders, diabetes mellitus, and various connective tissue disorders but is rarely associated with cardiomyopathy. 1. Introduction Celiac disease is characterized by chronic malabsorption in susceptible individuals who ingest grains containing gluten, such as wheat, barley, and rye. Until recently, celiac disease was believed to be relatively uncommon. However, a recent report from Finland estimates its prevalence at 1% in the general population [1]. Celiac disease is associated frequently with iron-deﬁciency anemia, dermatitis herpetiformis, selec- tive IgA deﬁciency [2], thyroid disorders [3], diabetes mellitus [4, 5], and various connective tissue disorders [6– 9]. Cardiomyopathy associated with celiac disease is reported infrequently [10–13]. 2. Report of a Case A 3-years- old girl, with family antecedents of a sister who died at 9 months and a brother who died at 6 months in circumstances which are not determined, was admitted to our department with a dyspnea and life-threatening cardio- miopatia dilatativa. Results of a physical examination revealed the following: failure to thrive, a blood pressure of 87/48 mm Hg, a heart rate of 176 beats/min with galloping rhythm, and respiratory rate 57 resp/min with pulmonary crackles in bases. Findings were normal for the rest of the physical examination. Laboratory ﬁndings show a hypochrome microcytic anemia (Hg 6.6 gr/dL), hypoalbuminaemia (27 g/L), hypertransaminasemia (ALT 448, AST 114 ij/L), high creatine phosphokinase (CPK) level (1280 ij/L) with MB fraction 76 ij/L (reference range 19 ij/L). Cholesterol, trigly- ceride levels, and renal function tests were within normal limits. Chest radiography revealed cardiomegaly and right pulmonary consolidation, and echocardiography showed global hypokinesis with a left ventricular dilatation EDD 41 mm and ejection fraction of 39–45%, without valvular problem and an elevated pressure ﬁlling of the left heart (Figure 1). The pulmonary arterial pressures were also elevated. Serology testings for inﬂuenza A, inﬂuenza B, adenovirus, RSV, and parainﬂuenza were negative. Tissue transglutaminase antibody level was positive >200 U/mL (reference range, <10 U/mL) and anti-endo- mysial IgA antibody titre was positive (1 : 160). She was typed for HLADQ B1∗02, ∗03 DRB1∗03∗04. by polymerase chain reaction. On the third day of hospitalisation the patient died. The anatomopathologic exam of duodenum in autopsy shows the aspect of a villous atrophy stage Marsh 3c thus conﬁrming the diagnosis (Figure 2). The anatomopathologic exam of heart in autopsy shows dilated cardiomyopathy (Figure 3). The diagnosis of dilated cardiomyopathy (DMC) associated to celiac disease has been kept. The retrospective review of the medical ﬁle of her sister shows that she was taken care for celiac disease discovered in front of a microcytary hypochrome anemia at 7.5 gr/dL of hemoglobin which was explored.