Persistent myocardial ischaemia due to anaemia in a patient with coeliac disease – A case report

Introduction: Coeliac disease (CD) is a systemic disease of inappropriate immune response to gluten, and is associated with 10% increased risk of cardiovascular disease. Here we present a case of a young patient with persistent myocardial ischaemia due to iron-deficiency anaemia despite oral iron supplementation, who was eventually diagnosed with CD. Case report: A 36-year-old man was admitted to the cardiology department due to ST-elevation myocardial infarction of the inferior wall. Emergency coronary angiography showed occlusion of the right coronary artery and intermediate-diameter lesions in other arteries. Primary percutaneous coronary intervention with stent implantation to the right coronary artery was performed. Despite the successful intervention, the patient presented with recurrent chest pain, persistent tachycardia up to 120 beats per minute and syncope. Coronary angiography was repeated and the intermediate-diameter lesions were proved insignificant. Laboratory tests revealed microcytic anaemia with haemoglobin level of 6.5 g/dL, despite oral iron supplementation in the pre-hospital period. An emergency gastroscopy with duodenoscopy revealed flat duodenal mucosa. The duodenal biopsy confirmed the diagnosis of CD. Strict gluten-free diet and further iron supplementation were recommended. Two months later the patient presented with no recurrent chest pain and normal haemoglobin concentration. Conclusions: Diagnosis of CD with atypical presentation can be difficult. Iron-deficiency anaemia refractory to oral iron supplementation should always raise the suspicion of CD, even without typical gastrointestinal manifestation.