[Pericardial effusion in celiac disease--an incidental finding?]

Ultrasound revealed evidence of pericardial effusion in 13 out of 26 children with coeliac disease. In a prospective study, we tried to analyse the causes underlying this high incidence of pericardial effusion.

Twenty-six patients were evaluated. Coeliac disease was diagnosed by intestinal biopsy. All children underwent sonography and a laboratory work-up including endomysial antibodies and serum selenium and iron concentrations.

Patients with pericardial fluid showed no difference compared to those without effusion in regard to ECG, chest x-ray, red and white blood cell count, serum enzymes, serum protein as well as iron levels. The mean value of serum selenium was lower and endomysial antibody titre was higher in patients with pericardial effusion. However, due to the wide range, a clear distinction between the two groups was impossible. In all other investigated parameters there was no difference between patients with and without pericardial effusion. Patients with effusion had a higher frequency of viral infection.

The high incidence of pericardial effusion in patients with coeliac disease appears to be governed by a multifactorial mechanism. A high endomysial antibody titre as well as selenium deficiency may play a role as a predisposing factor. Viral infection due to reduced immunological competence in conjunction with a hampered ability to eliminate toxic free radicals might cause blood vessel dysfunction, resulting in (asymptomatic) pericardial effusion. The fact that most of these patients were diagnosed during the cold season, with anamnestic evidence of viral infection shortly before the diagnosis, and the fact that adult patients with dilative cardiomypathy show a greater prevalence of coeliac disease, supports the view that coeliac disease is systemic in nature.