Pericardial effusion in coeliac disease - Just a coincidence?

Objective: Ultrasound revealed evidence of pericardial effusion in 13 out o f 26 children with coeliac disease. In a prospective study, we tried to ana lyse the causes underlying this high incidence of pericardial effusion. Patients and methods: Twenty-six patients were evaluated. Coeliac disease w as diagnosed by intestinal biopsy. All children underwent sonography and a laboratory work-up including endomysial antibodies and serum selenium and i ron concentrations. Results: Patients with pericardial fluid showed no difference compared to t hose without effusion in regard to EGG, chest x-ray, red and white blood ce ll count, serum enzymes, serum protein as well as iron levels. The mean val ue 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 investigat ed parameters there was no difference between patients with and without per icardial effusion. Patients with effusion had a higher frequency of viral i nfection. Conclusion: The high incidence of pericardial effusion in patients with coe liac disease appears to be governed by a multifactorial mechanism. A high e ndomysial antibody titre as well as selenium deficiency may play a role as a predisposing factor. Viral infection due to reduced immunological compete nce in conjunction with a hampered ability to eliminate toxic free radicals might cause blood vessel dysfunction, resulting in (asymptomatic) pericard ial effusion. The fact that most of these patients were diagnosed during th e cold season, with anamnestic evidence of viral infection shortly before t he diagnosis, and the fact that adult patients with dilative cardiomypathy show a greater prevalence of coeliac disease, supports the view that coelia c disease is systemic in nature.