DILATED CARDIOMYOPATHY AND TYPE I DIABETES IN A PATIENT WITH CELIAC DISEASE

Abstract

Association of Celiac Disease (CD) with Type I diabetes (T1D) and independently with Dilated Cardiomyopathy (DC) has been cited in literature multiple times. Although no definitive ethiology has been identified in patients with CD that would exacerbate other autoimmune conditions multiple theories have been developed. It has been observed that children with CD and T1D have significant improvement in their glycemic index once adherent to Gluten Free Diet (GFD). Equally interesting, it has been noted that children with CD and DC have improvement of their cardiac function once adherent GFD. In fact prevalence of DC is higher in patients with CD as well as patients whose relatives have positive Celiac serology when compared to general population. Furthermore, increased incidence of tissue transglutaminase (TTG) and anti endomysial antibodies (EMA) in patients with end stage heart failure does not coincide with concominant CD, eluding to a potential common mechanism that can lead to different diseases. We present an adolescent who developed CD after several years of T1D whose condition was further complicated by acute onset DC. At the initial diagnosis of CD, he showed elevated TTG, EMA, and high serum levels of zonulin, a modulator of intercellular tight junctions that has been recently associated to the pathogenesis of both CD and T1D. With adherence to GFD, his CD serology tests normalized, his glycemic index got better, and his cardiac function improved on consequent evaluations, ultimately avoiding inevitable heart transplantation.