CELIAC DISEASE AS HEART FAILURE: AN UNUSUAL PRESENTATION

Celiac sprue, one of the major causes of chronic diarrhea, is an autoimmune inflammatory disease affecting the small bowel and is caused by increased sensitivity to the gluten-containing diet and related proteins resulting in the villi's damage and effacement, causing malabsorption, steatorrhea, bloating, weight loss, and chronic diarrhea. It is a relatively common disease affecting approximately 1% population in many different countries around the globe. It can also have extraintestinal manifestations such as dermatitis herpetiform, delayed growth, neurologic disease, liver disease, and iron deficiency anemia. We present a case of a female patient who developed heart failure secondary to iron deficiency due to celiac disease. A 13-year-old female patient presented to the emergency department with a complaint of shortness of breath for 2 days. The patient had a past medical history significant for abdominal discomfort, bloating, and non-bloody diarrhea associated with food intake for 2 years. On general examination, she had evident pallor visible on the palms and lower conjunctiva. Spooning of the nails (koilonychia) was also visible. Bilateral crackles in both lungs bases, abdominal ascites, raised JVD, and pedal edema was also noted. Clinically she was diagnosed with anemia and heart failure. Diet counseling restricting salt and water for heart failure was done while aiming for treating the cause, which was iron deficiency anemia and celiac disease. Intravenous Iron was given as she was already having gastrointestinal symptoms, and the patient improved significantly. A multidisciplinary approach involving cardiology, gastroenterology, and dietary consults was adopted, and the patient recovered over several days