Celiac disease with exocrine pancreatic insufficiency and dilated cardiomyopathy in pediatric patient: A rare case report

Abstract

Introduction: There are several clinical manifestations of celiac disease, an autoimmune enteropathy caused by gluten intake, including extra-intestinal and gastrointestinal symptoms. Although it is linked to dilated cardiomyopathy and exocrine pancreatic insufficiency, it rare for children with celiac disease to have these disorders concurrently. Case presentation: We describe the case of a five-year-old boy with biopsy-confirmed celiac disease who had chronic diarrhea, vomiting, and failure to grow properly despite strictly following a gluten-free diet. Investigations revealed severe deficiency of pancreatic enzymes and dilated cardiomyopathy. Treatment with pancreatic enzyme supplement resulted in significant improvement on follow up. Clinical discussion: Celiac disease is characterized by various clinical features which may involve cardiovascular problems. However, the occurrence of both exocrine pancreatic insufficiency and dilated cardiomyopathy in children with celiac disease is extremely uncommon. There is limited evidence regarding the use of pancreatic enzyme supplements in the treatment of such patients; however, our patient recovered with this treatment unexpectedly. Conclusion: This case highlights the significance of considering uncommon coexisting conditions in children with celiac disease who display atypical symptoms, this is crucial because it can result in life-threatening situations. Consequently, it is essential to promptly identify and treat conditions such as exocrine pancreatic insufficiency and dilated cardiomyopathy and screen these patients for celiac disease in order to enhance patient outcomes.

Keywords

• Celiac disease
• Gluten free diet
• Pancreatic insufficiency
• Dilated cardiomyopathy
• Pancreatic enzyme supplements