International Journal of Celiac Disease, 2015, Vol. 3, No. 1, 31-32 Available online at http://pubs.sciepub.com/ijcd/3/1/5 © Science and Education Publishing DOI:10.12691/ijcd-3-1-5 Two Exceptional Complications Revealing Celiac Disease: Ischemic Cardiomyopathy and Pellagra Imed Ben Ghorbel 1 , Raouf Hajji 2,* , Nabil Bel Feki 1 , Thouraya Ben Salem 1 , Mounir Lamloum 1 , Mohammed Habib Houman 1 1 Internal Medicine Department, University Hospital la Rabta, Tunis, Tunisia 2 Internal Medicine Department, Sidi Bouzid Regional Hospital, Sidi Bouzid, Tunisia *Corresponding author: raouf.hajji@yahoo.fr Received January 11, 2015; Revised January 15, 2015; Accepted January 17, 2015 Abstract Pellagra is an exceptional skin involvement in celiac disease. Ischemic cardiomyopathy is another rare event in celiac disease. Its pathogenesis remains not yet elucidated. We report a case of a 34- year old patient of presenting with pellagra and cardiomyopathy revealing a celiac disease. Keywords: pellagra, ischemic heart disease, celiac disease Cite This Article: Imed Ben Ghorbel, Raouf Hajji, Nabil Bel Feki, Thouraya Ben Salem, Mounir Lamloum, and Mohammed Habib Houman, “Two Exceptional Complications Revealing Celiac Disease: Ischemic Cardiomyopathy and Pellagra.” International Journal of Celiac Disease, vol. 3, no. 1 (2015): 31-32. doi: 10.12691/ijcd-3-1-5. 1. Introduction Pellagra (or “rough skin,” from the Italian pelle agra) is an exceptional skin involvement in celiac disease due to tryptophan and B3 vitamin (niacin) deficiency [1]. Ischemic cardiomyopathy is another rare event in celiac disease [2]. Its pathogenesis remains not yet elucidated. We report a case of a patient presenting with pellagra and cardiomyopathy revealing a celiac disease. 2. Case Report A 34-year-old male patient was admitted in intensive care unit of cardiology in 2009 for acute chest pain. He was not smoker neither alcohol consumer. He had no family nor personal history of coronary artery disease. The myocardial infarction was diagnosed and coronary angiography concluded to severe stenosis of the anterior interventricular artery. It was rapidly complicated by severe heart failure. The heart ultrasound imaging has showed dilated cardiomyopathy with systolic ejection fraction at 25 %. The patient was treated by aspirin, ramipril, simvastatin, and nebivolol. Three years later, he developed diffuse red skin lesions on the face and hands (Figure 1), beefy red glossitis and high skin sensitivity to sunlight. He reported also chronic diarrhea with 4 or more watery stools/ day for several months. He presented impaired general condition with moderate asthenia and weight loss. Physical examination showed mitral holosystolic murmur and lower limbs edema. Dermatologic examination revealed desquamation, erythema, and keratosis of sun-exposed areas especially on the face, hands and feet. Figure 1. Lesions of pellagra: diffuse red skin lesions on the face and hands