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Fenski M, Abazi E, Gröschel J, Hadler T, Kappelmayer D, Kolligs F, Prieto C, Botnar R, Kunze KP, Schulz-Menger J. Cardiovascular magnetic resonance reveals myocardial involvement in patients with active stage of inflammatory bowel disease. Clin Res Cardiol 2024:10.1007/s00392-024-02503-5. [PMID: 39102000 DOI: 10.1007/s00392-024-02503-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 07/22/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND Active inflammatory bowel disease (A-IBD) but not remission (R-IBD) has been associated with an increased risk of cardiovascular death and hospitalization for heart failure. OBJECTIVES Using cardiovascular magnetic resonance (CMR), this study aims to assess adverse myocardial remodeling in patients with IBD in correlation with disease activity. METHODS Forty-four IBD patients without cardiovascular disease (24 female, median-age: 39.5 years, 26 A-IBD, 18 R-IBD) and 44 matched healthy volunteers (HV) were prospectively enrolled. The disease stage was determined by endoscopic and patient-reported criteria. Participants underwent CMR for cardiac phenotyping: cine imaging and strain analysis were performed to assess ventricular function. T1 mapping, extracellular volume and late-gadolinium enhanced images were obtained to assess focal and diffuse myocardial fibrosis. Simultaneous T1 and T2 elevation (T1 > 1049.3 ms, T2 > 54 ms) was considered to indicate a myocardial segment was inflamed. RESULTS 16/44 (16.4%) IBD patients described dyspnea on exertion and 10/44 (22.7%) reported chest pain. A-IBD patients showed impaired ventricular function, indicated by reduced global circumferential and radial strain despite preserved left-ventricular ejection fraction. 16% of all IBD patients had focal fibrosis in a non-ischemic pattern. A-IDB patients had increased markers of diffuse left ventricular fibrosis (T1-values: A-IBD: 1022.0 ± 34.83 ms, R-IBD: 1010.10 ± 32.88 ms, HV: 990.61 ± 29.35 ms, p < .01). Significantly more participants with A-IDB (8/26, 30.8%) had at least one inflamed myocardial segment than patients in remission (0/18) and HV (1/44, 2.3%, p < .01). Markers of diffuse fibrosis correlated with disease activity. CONCLUSION This study, using CMR, provides evidence of myocardial involvement and patterns of adverse left ventricular remodeling in patients with IBD. CLINICAL TRIAL REGISTRATION ISRCTN30941346.
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Affiliation(s)
- Maximilian Fenski
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research CenterMax-Delbrück Center for Molecular MedicineDepartment of Cardiology and Nephrology, Charité Medical Faculty, HELIOS Klinikum Berlin Buch, Charité - Universitätsmedizin Berlin Lindenberger Weg 80, 13125, Berlin, Germany
| | - Endri Abazi
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research CenterMax-Delbrück Center for Molecular MedicineDepartment of Cardiology and Nephrology, Charité Medical Faculty, HELIOS Klinikum Berlin Buch, Charité - Universitätsmedizin Berlin Lindenberger Weg 80, 13125, Berlin, Germany
| | - Jan Gröschel
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research CenterMax-Delbrück Center for Molecular MedicineDepartment of Cardiology and Nephrology, Charité Medical Faculty, HELIOS Klinikum Berlin Buch, Charité - Universitätsmedizin Berlin Lindenberger Weg 80, 13125, Berlin, Germany
| | - Thomas Hadler
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research CenterMax-Delbrück Center for Molecular MedicineDepartment of Cardiology and Nephrology, Charité Medical Faculty, HELIOS Klinikum Berlin Buch, Charité - Universitätsmedizin Berlin Lindenberger Weg 80, 13125, Berlin, Germany
| | - Diane Kappelmayer
- Department of Internal Medicine and Gastroenterology, HELIOS Klinikum Berlin Buch, Berlin, Germany
| | - Frank Kolligs
- Department of Internal Medicine and Gastroenterology, HELIOS Klinikum Berlin Buch, Berlin, Germany
| | - Claudia Prieto
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rene Botnar
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
- Institute for Biological and Medical Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Karl-Philipp Kunze
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- MR Research Collaborations, Siemens Healthcare Limited, Camberley, UK
| | - Jeanette Schulz-Menger
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research CenterMax-Delbrück Center for Molecular MedicineDepartment of Cardiology and Nephrology, Charité Medical Faculty, HELIOS Klinikum Berlin Buch, Charité - Universitätsmedizin Berlin Lindenberger Weg 80, 13125, Berlin, Germany.
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
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Andrei V, D'Ettore N, Scheggi V, di Mario C. Mesalazine-induced myopericarditis: a case series. Eur Heart J Case Rep 2023; 7:ytad424. [PMID: 37719002 PMCID: PMC10504860 DOI: 10.1093/ehjcr/ytad424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 08/07/2023] [Accepted: 08/30/2023] [Indexed: 09/19/2023]
Abstract
Background Inflammatory bowel diseases (IBD) are characterized by chronic inflammation of the gastrointestinal tract but can have multiorgan involvement. Mesalazine (5-ASA) is a key therapeutic agent in IBD. Mesalazine has rare but potentially life-threatening side effects such as cardiac injury. Case summary We present two cases of myopericarditis, documented also with cardiac magnetic resonance, that we attributed to 5-ASA hypersensitivity: the first is a young woman with ulcerative colitis who developed myopericarditis after the initiation of 5-ASA, with a good clinical response after discontinuation; the second is a 79-year-old man who developed symptoms of heart failure after the diagnosis of IBD and the introduction of 5-ASA. Discussion Mesalazine may cause rare but potentially life-threatening cardiac injury, which can be difficult to distinguish from acute IBD-induced cardiac inflammation.
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Affiliation(s)
- Valentina Andrei
- Division of Structural Interventional Cardiology, University Hospital Careggi, Largo Brambilla 3, 50133 Florence, Italy
- Department of Clinical & Experimental Medicine, University Hospital Careggi, Largo Brambilla 3, 50133 Florence, Italy
| | - Nicoletta D'Ettore
- Division of Structural Interventional Cardiology, University Hospital Careggi, Largo Brambilla 3, 50133 Florence, Italy
- Department of Clinical & Experimental Medicine, University Hospital Careggi, Largo Brambilla 3, 50133 Florence, Italy
| | - Valentina Scheggi
- Department of Clinical & Experimental Medicine, University Hospital Careggi, Largo Brambilla 3, 50133 Florence, Italy
- Division of Cardiovascular and Perioperative Medicine, University Hospital Careggi, Largo Brambilla 3, 50133 Florence, Italy
| | - Carlo di Mario
- Division of Structural Interventional Cardiology, University Hospital Careggi, Largo Brambilla 3, 50133 Florence, Italy
- Department of Clinical & Experimental Medicine, University Hospital Careggi, Largo Brambilla 3, 50133 Florence, Italy
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Caio G, Lungaro L, Caputo F, Muccinelli M, Marcello MC, Zoli E, Volta U, De Giorgio R, Zoli G. Recurrent myocarditis in a patient with active ulcerative colitis: a case report and review of the literature. BMJ Open Gastroenterol 2021; 8:bmjgast-2020-000587. [PMID: 33722804 PMCID: PMC7970288 DOI: 10.1136/bmjgast-2020-000587] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/27/2021] [Accepted: 02/02/2021] [Indexed: 12/13/2022] Open
Abstract
Inflammatory bowel diseases such as ulcerative colitis (UC) may be complicated by several extraintestinal manifestations. These involve joints, skin, eyes and less commonly lungs and heart. Myocarditis may result from the toxic effect of drugs (ie, mesalazine) commonly used for the treatment of UC or due to infections (eg, Coxsackieviruses, enteroviruses, adenovirus). Here, we report a case of a 26-year old man affected by UC and complicated by two episodes of myocarditis. Both episodes occurred during two severe exacerbations of UC. However, in both cases the aetiology of myocarditis remains uncertain being ascribable to extraintestinal manifestation, drug toxicity or both.
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Affiliation(s)
- Giacomo Caio
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy.,Mucosal Immunology and Biology Research Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Lisa Lungaro
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy.,Department of Internal Medicine, SS. Annunziata Hospital, Cento, University of Ferrara, Ferrara, Italy
| | - Fabio Caputo
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy.,Department of Internal Medicine, SS. Annunziata Hospital, Cento, University of Ferrara, Ferrara, Italy
| | - Maria Muccinelli
- Department of Internal Medicine, SS. Annunziata Hospital, Cento, University of Ferrara, Ferrara, Italy
| | - Maria Caterina Marcello
- Department of Internal Medicine, SS. Annunziata Hospital, Cento, University of Ferrara, Ferrara, Italy
| | - Eleonora Zoli
- Department of Internal Medicine, SS. Annunziata Hospital, Cento, University of Ferrara, Ferrara, Italy
| | - Umberto Volta
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Roberto De Giorgio
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Giorgio Zoli
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy .,Department of Internal Medicine, SS. Annunziata Hospital, Cento, University of Ferrara, Ferrara, Italy
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Taha ME, Abdalla A, Al-Khafaji J, Malik S. Mesalamine-Induced Myopericarditis: A Case Report and Literature Review. Cardiol Res 2019; 10:59-62. [PMID: 30834061 PMCID: PMC6396800 DOI: 10.14740/cr820] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 12/27/2018] [Indexed: 01/05/2023] Open
Abstract
Inflammation of the myocardium (myocarditis) or pericardium (pericarditis) or both (myopericarditis) as side effects of mesalamine, a drug widely used in the treatment of inflammatory bowel disease, is a rare, but potentially lethal complication. We report a case of myopericarditis occurring in a young Caucasian woman 14 days following initiation of mesalamine therapy for treatment of a newly diagnosed ulcerative colitis (UC). She presented with pleuritic chest pain, elevated troponin levels and pre-syncope. The diagnosis of myopericarditis was made based on the clinical features, electrocardiogram (EKG) and cardiac magnetic resonance, which showed trace pericardial effusion. The patient’s symptom and condition were dramatically improved upon discontinuing mesalamine, and a full recovery was achieved. Mesalamine-induced inflammation of the myocardium (myocarditis) or pericardium (pericarditis) or both (myopericarditis) is rare, but has fatal side effects. Early recognition of these side effects by clinicians and patients is important to prevent progression of the inflammation. Furthermore, patients should be educated to seek urgent medical attention if cardiac symptoms arise.
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Affiliation(s)
- Mohamed E Taha
- Department of Internal Medicine, University of Nevada - Reno, School of Medicine, Reno, NV 89502, USA
| | - Abubaker Abdalla
- Department of Internal Medicine, University of Nevada - Reno, School of Medicine, Reno, NV 89502, USA
| | - Jaafar Al-Khafaji
- Department of Internal Medicine, University of Nevada - Reno, School of Medicine, Reno, NV 89502, USA
| | - Samira Malik
- Department of Internal Medicine, University of Nevada - Reno, School of Medicine, Reno, NV 89502, USA
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Sehgal P, Colombel JF, Aboubakr A, Narula N. Systematic review: safety of mesalazine in ulcerative colitis. Aliment Pharmacol Ther 2018; 47:1597-1609. [PMID: 29722441 DOI: 10.1111/apt.14688] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 07/13/2017] [Accepted: 04/05/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Mesalazine is the most commonly prescribed medication for mild to moderate ulcerative colitis. It is generally well tolerated with some reported side effects. AIM To summarise adverse drug events to mesalazine and recommend techniques for management. Furthermore, to determine if there is a dose-dependent relationship between high (>2.4 g/day) vs low dosing (≤2.4 g/day) and occurrence of adverse drug events. METHODS A literature search for relevant studies from inception to 1 December 2017 of the MEDLINE database was conducted. Two reviewers screened all titles identified. Data obtained from randomised controlled trials was used to estimate incidence rates of each adverse event. Two reviewers independently assessed methodological risk of bias and performed data extraction. RESULTS 3581 articles were initially considered. Of these, 3573 were screened, 622 reviewed and 91 included. Adverse events attributed to mesalazine included inflammatory reactions, pancreatitis, cardiotoxicity, hepatotoxicity, musculoskeletal complaints, respiratory symptoms, nephropathies and sexual dysfunction. There does not appear to be a dose-dependent relationship of mesalazine and occurrence of adverse events. CONCLUSION Patients on mesalazine should be monitored for worsening of ulcerative colitis and development of new onset organ dysfunction. High-dose mesalazine appears to have similar safety profile as low dose, and is not associated with greater risk of adverse events. Prior to placing a patient on mesalazine, baseline liver and renal function should be evaluated. Renal function should be periodically assessed, whereas other testing should be performed depending on development of symptoms.
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Affiliation(s)
- P Sehgal
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J-F Colombel
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - A Aboubakr
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - N Narula
- Department of Medicine, Division of Gastroenterology, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
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Shabtaie SA, Tan NY, Parikh RS, Papadakis KA. Concurrent Sweet's syndrome and myopericarditis following mesalamine therapy. BMJ Case Rep 2018; 2018:bcr-2017-223851. [PMID: 29574433 DOI: 10.1136/bcr-2017-223851] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Mesalamine, or 5-aminosalicylic acid, is a frequently used medication for the treatment of inflammatory bowel disease (IBD). We report the case of a 40-year-old woman recently diagnosed with IBD and started on mesalamine, who presented with new onset tender skin lesions 3 days following medication administration. One day following the onset of skin lesions, the patient developed acute chest pain, shortness of breath, ECG changes, troponemia, C-reactive protein elevation and pericardial enhancement on cardiac MRI consistent with myopericarditis. Subsequent skin biopsy confirmed the diagnosis of Sweet's syndrome. On cessation of the drug, both the skin lesions and the cardiac symptoms resolved in combination with anti-inflammatory therapy. While mesalamine has been previously associated with myocarditis and pericarditis, to our knowledge this is the first case of coexisting Sweet's syndrome with myopericarditis in the context of mesalamine therapy.
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Affiliation(s)
- Samuel A Shabtaie
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Nicholas Y Tan
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Riddhi S Parikh
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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8
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Miocarditis inducida por mesalazina. Med Clin (Barc) 2016; 146:e7-8. [DOI: 10.1016/j.medcli.2015.04.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 04/28/2015] [Accepted: 04/30/2015] [Indexed: 11/18/2022]
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Baker WL, Saulsberry WJ, Elliott K, Parker MW. Cardiac MRI-confirmed mesalamine-induced myocarditis. BMJ Case Rep 2015; 2015:bcr-2015-210689. [PMID: 26341161 DOI: 10.1136/bcr-2015-210689] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
A 38-year-old Caucasian man with a medical history significant for inflammatory bowel disease (IBD) and mesalamine use presented to the emergency department with stabbing, pleuritic, substernal chest pain over the previous 2 days. Findings of leucocytosis, elevated cardiac enzymes and inflammatory markers, T-wave or ST-segment abnormalities and left ventricular systolic dysfunction suggested mesalamine-induced myocarditis. However, a cardiac MRI confirmed the diagnosis. Signs and symptoms improved within days of withdrawal of mesalamine, and initiation of corticosteroids and follow-up studies within the next year were unremarkable. Importantly, the diagnosis of mesalamine-induced myocarditis confirmed via cardiac MRI is a step rarely performed in published cases.
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Affiliation(s)
- William L Baker
- Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, Connecticut, USA
| | - Whitney J Saulsberry
- Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, Connecticut, USA
| | - Kaitlyn Elliott
- Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, Connecticut, USA
| | - Matthew W Parker
- Department of Cardiology, Hartford Hospital, Hartford, Connecticut, USA
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Mesalazine-Induced Myopericarditis in a Patient with a Recent Diagnosis of Crohn's Disease: Apropos of a Case. Case Rep Cardiol 2015; 2015:728310. [PMID: 26266055 PMCID: PMC4523686 DOI: 10.1155/2015/728310] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 07/06/2015] [Indexed: 11/17/2022] Open
Abstract
Mesalazine- (5-aminosalicylic acid-) containing products are a well-known treatment for inflammatory bowel disease, often as first line. Myocarditis is recognized as a very rare possible side effect of this drug treatment. We present a case of mesalazine-induced myopericarditis that was successfully improved by immediate cessation of the medication.
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Fleming K, Ashcroft A, Alexakis C, Tzias D, Groves C, Poullis A. Proposed case of mesalazine-induced cardiomyopathy in severe ulcerative colitis. World J Gastroenterol 2015; 21:3376-3379. [PMID: 25805947 PMCID: PMC4363770 DOI: 10.3748/wjg.v21.i11.3376] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 10/25/2014] [Accepted: 12/01/2014] [Indexed: 02/06/2023] Open
Abstract
Five-amino salicylic acids are recommended for use in the management of inflammatory bowel disease, cardiac complications are a rare although recognised phenomenon. This report aims to highlight this serious but rare adverse reaction. We report here a case of a young man presenting with cardiogenic shock in the context of recent mesalazine treatment in severe ulcerative colitis.
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12
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Five-aminosalicylic Acid: an update for the reappraisal of an old drug. Gastroenterol Res Pract 2015; 2015:456895. [PMID: 25685145 PMCID: PMC4320793 DOI: 10.1155/2015/456895] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 12/29/2014] [Indexed: 12/17/2022] Open
Abstract
Inflammatory bowel disease (IBD) comprises several conditions with chronic or recurring immune response and inflammation of the gastrointestinal apparatus, of which ulcerative colitis and Crohn's disease are the commonest forms. This disease has a significant prevalence and it is of an unknown aethiology. Five-aminosalicylic acid (5-ASA) and its derivatives are among the oldest drugs approved for the treatment of the IBD. In this review we reapprise aspects of 5-ASA mechanism of action, safety, and efficacy that in our opinion make it a valuable drug that can be fruitfully tailored in personalised treatments as a therapeutic option alongside other immune-modifying agents.
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Coman RM, Glover SC, Gjymishka A. Febrile pleuropericarditis, a potentially life-threatening adverse event of balsalazide – case report and literature review of the side effects of 5-aminosalicylates. Expert Rev Clin Immunol 2014; 10:667-75. [DOI: 10.1586/1744666x.2014.902313] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Galvão Braga C, Martins J, Arantes C, Ramos V, Vieira C, Salgado A, Magalhães S, Correia A. Mesalamine-induced myocarditis following diagnosis of Crohn's disease: A case report. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.repce.2012.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Galvão Braga C, Martins J, Arantes C, Ramos V, Vieira C, Salgado A, Magalhães S, Correia A. Mesalamine-induced myocarditis following diagnosis of Crohn's disease: a case report. Rev Port Cardiol 2013; 32:717-20. [PMID: 23993290 DOI: 10.1016/j.repc.2012.12.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Accepted: 12/07/2012] [Indexed: 02/07/2023] Open
Abstract
Mesalamine is a common treatment for Crohn's disease, and can be rarely associated with myocarditis through a mechanism of drug hypersensitivity. We present the case of a 19-year-old male who developed chest pain two weeks after beginning mesalamine therapy. The electrocardiogram showed slight ST-segment elevation with upward concavity in the inferolateral leads; blood tests demonstrated elevated troponin I and the echocardiogram revealed moderately depressed left ventricular systolic function with global hypocontractility. Cardiac magnetic resonance imaging confirmed the diagnosis of myocarditis, revealing multiple areas of subepicardial fibrosis. The onset of symptoms after mesalamine, and improvement of chest pain, cardiac biomarkers and left ventricular systolic function after discontinuing the drug, suggest that our patient suffered from a rare drug-hypersensitivity reaction to mesalamine.
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Ennezat PV, Noel C, Tillie-Leblond I, Le Jemtel TH, Vincentelli A. Crohn's disease and nontropical endomyocardial fibrosis. Cardiology 2013; 125:258-60. [PMID: 23839293 DOI: 10.1159/000351085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 03/28/2013] [Indexed: 11/19/2022]
Abstract
The pathogenesis of endomyocardial fibrosis (EMF) is poorly understood. EMF may result from autoimmune scarring of the endocardium. Clinically, EMF presents as a restrictive cardiomyopathy. EMF is commonly reported in tropical countries. In Western countries, EMF is associated with hypereosinophilia and reported as Loeffler endocarditis. We report a Caucasian patient with Crohn's disease and EMF, and discuss a possible linkage between the two conditions.
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Affiliation(s)
- Pierre Vladimir Ennezat
- Department of Cardiology, Université Lille Nord de France, UDSL, Centre Hospitalier Régional et Universitaire de Lille, Lille, France. ennezat @ yahoo.com
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Sabatini T, Filippini A, Nicosia F, Preti S, Bertoli M. Recurrence of myocarditis after mesalazine treatment for ulcerative colitis: a case report. Inflamm Bowel Dis 2013; 19:E46-8. [PMID: 22517473 DOI: 10.1002/ibd.22985] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Perez-Colon E, Dadlani GH, Wilmot I, Miller M. Mesalamine-induced myocarditis and coronary vasculitis in a pediatric ulcerative colitis patient: a case report. Case Rep Pediatr 2011; 2011:524364. [PMID: 22611512 PMCID: PMC3350175 DOI: 10.1155/2011/524364] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Accepted: 10/17/2011] [Indexed: 11/30/2022] Open
Abstract
Mesalamine-containing products are often a first-line treatment for ulcerative colitis. Severe adverse reactions to these products, including cardiovascular toxicity, are rarely seen in pediatric patients. We present a case of a 16-year-old boy with ulcerative colitis treated with Asacol, a mesalamine-containing product, who developed sudden onset chest pain after four weeks on therapy. Serial electrocardiograms showed nonspecific ST segment changes, an echocardiogram showed mildly decreased left ventricular systolic function with mild to moderate left ventricular dilation and coronary ectasia, and his troponins were elevated. Following Asacol discontinuation, his chest pain resolved, troponins were trending towards normal, left ventricular systolic function normalized, and coronary ectasia improved within 24 hours suggesting an Asacol-associated severe drug reaction. Mesalamine-induced cardiovascular toxicity, although rare, may represent a life-threatening disorder. Therefore, every patient presenting with acute chest pain should receive a workup to rule out this rare drug-induced disorder.
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Affiliation(s)
- Elimarys Perez-Colon
- Department of Pediatrics, University of South Florida, 2 Tampa General Circle, Tampa, FL 33606, USA
| | - Gul H. Dadlani
- Department of Pediatrics, University of South Florida, 2 Tampa General Circle, Tampa, FL 33606, USA
- All Children’s Hospital Heart Institute, Outpatient Care Center, 2nd Floor, 501 6th Street South Saint. Petersburg, FL 33701, USA
| | - Ivan Wilmot
- All Children’s Hospital Heart Institute, Outpatient Care Center, 2nd Floor, 501 6th Street South Saint. Petersburg, FL 33701, USA
| | - Michelle Miller
- All Children’s Hospital Heart Institute, Outpatient Care Center, 2nd Floor, 501 6th Street South Saint. Petersburg, FL 33701, USA
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Merceron O, Bailly C, Khalil A, Pontnau F, Hammoudi N, Dorent R, Michel PL. Mesalamine-induced myocarditis. Cardiol Res Pract 2010; 2010. [PMID: 20871830 PMCID: PMC2943131 DOI: 10.4061/2010/930190] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Revised: 08/15/2010] [Accepted: 08/24/2010] [Indexed: 12/22/2022] Open
Abstract
Nowadays mesalamine is a common treatment for Crohn's disease and hypersensitive reactions to this product have been reported. Yet there is limited information concerning mesalamine-induced myocarditis and its mechanism is not known. We described a case of mesalamine-induced myocarditis in Crohn's disease of the colon.
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Affiliation(s)
- Olivier Merceron
- Cardiology Department, Tenon University and Medical School, Assistance Publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2009. [DOI: 10.1002/pds.1654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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