TY - JOUR T1 - Dilated cardiomyopathy as the first presentation of coeliac disease: association or causation? JF - Clinical Medicine JO - Clin Med SP - 177 LP - 179 DO - 10.7861/clinmedicine.18-2-177 VL - 18 IS - 2 AU - Peysh Patel AU - Fraser Smith AU - Niamh Kilcullen AU - Nigel Artis Y1 - 2018/04/01 UR - http://www.rcpjournals.org/content/18/2/177.abstract N2 - Global ventricular impairment is a frequent presentation in clinical practice, but dissection of causative mechanisms from clinical associations is challenging. We present the case of a 19-year-old man who presented with dilated cardiomyopathy as the first presentation of coeliac disease. The manifestation of iron deficiency anaemia prompted gastroenterology input and enabled accurate diagnosis. It is unclear whether coeliac disease was simply coexistent or directly implicated in pathophysiology. Mechanisms may relate to nutritional deficiencies or autoimmune myocarditis arising from cross-reactivity. We advocate early multidisciplinary involvement in such contexts to aid with management strategy. Despite adherence to a gluten-free diet, ventricular dysfunction persisted and he has been referred to a cardiac transplant centre. ER -