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Wang YY, Shi W, Wang J, Li Y, Tian Z, Jiao Y. Myocarditis as an extraintestinal manifestation of ulcerative colitis: A case report and review of the literature. World J Clin Cases 2022; 10:9750-9759. [PMID: 36186201 PMCID: PMC9516903 DOI: 10.12998/wjcc.v10.i27.9750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 03/25/2022] [Accepted: 08/17/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Although extraintestinal manifestations of inflammatory bowel disease (IBD) are well documented, myocarditis has only rarely been reported as an extraintestinal manifestation, and it can be fatal. The various clinical presentations and causes of myocarditis in IBD patients complicate making a correct and timely diagnosis.
CASE SUMMARY Here we report a 15-year-old boy who presented with myocarditis as the initial presentation of a relapse of ulcerative colitis. In reviewing the literature for cases of myocarditis complicating IBD, we found 21 other cases, allowing us to expand our understanding of the clinical presentation, diagnosis, management, and outcomes of this rare condition. The most frequent diagnostic clues for myocarditis in IBD patients are dyspnea, chest pain, tachycardia, raised cardiac biomarkers, and abnormalities on trans-thoracic echocardiography. Additionally, we discuss the etiology of myocarditis in IBD patients, which include an extraintestinal manifestation, the adverse effects of mesalamine and infliximab, selenium deficiency, and infection, to help provide a framework for diagnosis and management.
CONCLUSION Myocarditis as an extraintestinal manifestation of IBD can be life-threatening. Trans-thoracic echocardiogram and cardiac magnetic resonance may assist its diagnosis.
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Affiliation(s)
- You-Yang Wang
- Department of General Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Wen Shi
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Jian Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Yue Li
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Zhuang Tian
- Department of Cardiology and International Medical Service, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Yang Jiao
- Department of General Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
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Cesa K, Cunningham C, Harris T, Sunseri W. A Review of Extraintestinal Manifestations & Medication-Induced Myocarditis and Pericarditis in Pediatric Inflammatory Bowel Disease. Cureus 2022; 14:e26366. [PMID: 35911289 PMCID: PMC9334219 DOI: 10.7759/cureus.26366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 11/26/2022] Open
Abstract
Inflammatory bowel disease (IBD) is a systemic disorder where extraintestinal symptoms may involve virtually any organ system. Of these extraintestinal symptoms, those involving the heart are relatively rare but associated with significant morbidity. We reviewed the existing literature on noninfectious myocarditis and pericarditis in the pediatric IBD population, including extraintestinal manifestations (EIMs) of IBD and extraintestinal complications (EICs) from medication. We focused on the incidence, presentation, diagnosis, treatment, and outcomes for timely diagnosis and management of these potentially deadly diseases. In addition, we aim to identify and highlight the gaps in current knowledge for future studies and investigations.
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Successful Treatment with Corticosteroids in an 11-Year-Old Patient with Crohn's Disease and Myopericarditis-Case Report. Pediatr Rep 2022; 14:26-31. [PMID: 35076578 PMCID: PMC8788440 DOI: 10.3390/pediatric14010005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/29/2021] [Accepted: 01/07/2022] [Indexed: 12/02/2022] Open
Abstract
Extraintestinal manifestations (EIMs) are observed in 15-20% of patients with inflammatory bowel disease (IBD). One of the rare EIMs is myocarditis, the incidence of which is estimated at around 1%. The main cause of myocarditis is a viral infection. Other causes include autoimmune diseases and drug complications (sulfasalazine, mesalazine). We present the case of an 11-year-old girl with Crohn's disease (CD) with EIMs, manifested as hip joint inflammation and erythema nodosum. At the same time, the symptoms of myopericarditis appeared with changes in electrocardiogram (ECG), echocardiography and high troponin I concentration. Therapy with corticosteroids resulted in the resolution of skin lesions and cardiological symptoms. Systemic connective tissue diseases, viral and bacterial infections were excluded in the differential diagnosis. The suspicion of mesalazine-induced EIMs was also ruled out as the symptoms resolved despite continued therapy with mesalazine. No further recurrences of myopericarditis were observed.
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Affiliation(s)
- Kadriye Gayretli Yayla
- Department of Cardiology, Dr. Abdurrahman Yurtaslan Ankara Onkoloji Education and Research Hospital, Ankara, Turkey
| | - Çağri Yayla
- Department of Cardiology, 574949Ankara City Hospital, Ankara, Turkey
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Van Gils AJM, van Gijlswijk S, Taminiau JAJM, Marchau F, Van De Vijver E. Recurrent pericarditis as an extra-intestinal manifestation of ulcerative colitis in a 14-year-old girl. Clin Case Rep 2018; 6:1538-1542. [PMID: 30147900 PMCID: PMC6099011 DOI: 10.1002/ccr3.1562] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 12/24/2017] [Accepted: 01/14/2018] [Indexed: 12/14/2022] Open
Abstract
Pericarditis is a known complication of mesalazine in the treatment of ulcerative colitis. This case study illustrates that after diagnostic work-up, pericarditis should not always be attributed to the use of mesalazine. It may be the presentation of an extra-intestinal manifestation of ulcerative colitis. Restarting of mesalazine should be considered.
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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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Cincin A, Sunbul M, Kivrak T, Atas H, Sari I, Tigen K, Kani T, Akin H, Imeryuz N, Basaran Y. Evaluation of cardiac function by two-dimensional speckle tracking echocardiography in ulcerative colitis patients. Dig Dis Sci 2014; 59:3004-11. [PMID: 25023227 DOI: 10.1007/s10620-014-3274-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 06/27/2014] [Indexed: 01/14/2023]
Abstract
PURPOSE Although ulcerative colitis (UC) shows obvious similarities with other autoimmune diseases, cardiac consequences have not adequately introduced. The aim of our study was to evaluate left ventricular (LV) function in UC patients by using novel echocardiographic parameters. RESULTS Forty-five UC patients (mean age 37, 18 female) and 90 age- and sex-matched healthy volunteers (mean age 40, 38 female) included in the study. The mean disease activity score according to partial Mayo score was 2.16 ± 2.13. Mean global longitudinal strain (GLS) and global longitudinal strain rate (GLSR) measurements were significantly lower (-21.16 ± 2.71 vs. -23.36 ± 3.34; p < 0.001 and -1.33 ± 0.24 vs. -1.43 ± 0.24; p = 0.037, respectively), whereas global circumferential (-22.67 ± 3.66 vs. -23.37 ± 3.99; p = 0.140) and global radial strain (43.07 ± 8.58 vs. 44.12 ± 9.32; p = 0.545) measurements of the LV were similar in patients with UC compared with controls. The correlation coefficient (r) between GLS and partial Mayo score was -0.578 (p < 0.001). CONCLUSION Our study suggests that systolic cardiac deformation values are impaired in UC patients. Reduced GLS and GLSR might be an early indicator of cardiac involvement in this population.
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Affiliation(s)
- Altug Cincin
- Department of Cardiology, Faculty of Medicine, Marmara University, Istanbul, Turkey,
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9
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Bragagni G, Brogna R, Franceschetti P, Zoli G. Cardiac involvement in Crohn's disease: echocardiographic study. J Gastroenterol Hepatol 2007; 22:18-22. [PMID: 17201875 DOI: 10.1111/j.1440-1746.2006.04384.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Crohn's Disease (CD) commonly presents extra-intestinal manifestations, but cardiac involvement is considered rare. The aim of the present study was to assess cardiac involvement in CD and its possible correlation with activity, duration, localization and therapy. PATIENTS AND METHODS A group of 68 patients with CD and a control group of 60 healthy subjects were subjected to a transthoracic echocardiogram with Doppler study. RESULTS The study found overall morphologic alterations in 47/68 CD patients (69.11%) versus 12/60 controls (20.0%; P < 0.01); mitral valve prolapse in 20/68 CD patients (29.4%) versus 4/60 controls (6.6%; P < 0.01); and pericardial effusion in 13/68 CD patients (19.1%)versus 1/60 controls (1.6%; P < 0.01). The following findings were frequent, but without statistical significance: mitral insufficiency, 9/68 CD (13.2%) versus 3/60 controls (5.0%); tricuspidalic insufficiency, 8/68 CD (11.7%) versus 3/60 controls (5%); aortic insufficiency, 3/68 CD (4.4%) versus none in the control group; and decreased left ventricle ejection fraction, 5/68 CD (7.3%) versus none in the control group. Pericardial effusion was found to be related to CD activity (r = 0.375; P = 0.002) as well as decreased ejection fraction (r = 0.358; P = 0.003). No correlation with age, sex, duration, therapy or localization of disease was found. CONCLUSIONS These findings suggest that CD frequently determines cardiac involvement, although it is usually subclinical. The alteration of cytokine network, especially the elevated levels of tumor necrosis factor-alpha, could be implicated in the cardiac alterations because it was observed, as for raised oxidative stress, in other heart diseases.
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Affiliation(s)
- Gianpaolo Bragagni
- Department of Internal Medicine, SS Annunziata Hospital, Cento (Ferrara), Italy
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10
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Katsanos KH, Kitsanou M, Christodoulou D, Tsianos EV, Pappas C, Jihad AB, Fotopoulos A, Metafratzi ZM, Efremidis S. Reversible myocardial ischemia during Crohn's disease exacerbation in a 17-year-old boy. Inflamm Bowel Dis 2006; 12:1005-6. [PMID: 17012972 DOI: 10.1002/ibd.3780121011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Lhasbellaoui F, Faure C, Magnier S, Guillonneau M, Cézard JP, Navarro J, Jacqz-Aigrain E. [Hypertrophic cardiomyopathy complicating a prolonged corticotherapy for hemorrhagic rectocolitis]. Arch Pediatr 1997; 4:48-51. [PMID: 9084709 DOI: 10.1016/s0929-693x(97)84309-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The cardiac side-effects of corticosteroid therapy are very uncommon. CASE REPORT A girl with ulcerative colitis developed at the age of 8 years an acute digestive episode despite prednisolone and total parenteral nutrition. The patient was then given intravenous methylprednisolone (2 mg/kg/d). Polypnea appeared 25 days later while blood pressure remained normal. Echocardiography revealed a cardiac hypertrophy associated with a systolic anterior motion of the mitral valve. Cardiac symptoms and echography findings returned to normal after reduction of corticosteroid therapy and its administration via the oral route. CONCLUSION Hypertrophic cardiomyopathy has been described in preterms treated with dexamethasone for bronchopulmonary dysplasia. It is exceptional in older children under corticosteroid therapy and its mechanism remains unknown.
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Affiliation(s)
- F Lhasbellaoui
- Service de pharmacologie clinique, hôpital Robert-Debré, Paris, France
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12
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Weiss N, Rademacher A, Zoller WG, Schlöndorff D. Myocarditis and subcutaneous granulomas in a patient with Crohn's disease of the colon. Am J Med 1995; 99:434-6. [PMID: 7573101 DOI: 10.1016/s0002-9343(99)80194-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- N Weiss
- University of Munich, Medical Polyclinic, Germany
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Ekbom A, Helmick CG, Zack M, Holmberg L, Adami HO. Survival and causes of death in patients with inflammatory bowel disease: a population-based study. Gastroenterology 1992; 103:954-60. [PMID: 1499945 DOI: 10.1016/0016-5085(92)90029-x] [Citation(s) in RCA: 150] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Relative survival up to December 31, 1986 was analyzed for all patients diagnosed with ulcerative colitis (UC) (n = 2,509) and Crohn's disease (CD) (n = 1,469) within the Uppsala Region, Sweden 1965-1983. After 10 years survival was 96% of that expected for UC and CD. Patients with ulcerative proctitis, left-sided colitis, and pancolitis at diagnosis had relative survival rates of 98%, 96%, and 93% respectively. Survival did not differ by extent at diagnosis for patients with CD. After including prevalent cases, 684 deaths occurred compared with 481.1 expected deaths [standardized mortality ratio (SMR) = 1.4; 95% confidence interval (CI) = 1.3-1.5]. Inflammatory bowel disease was the main reason for this excess mortality. Colorectal cancer increased mortality (50 deaths observed vs. 15.2 expected). Death from other cancers were not greater than expected. Obstructive respiratory diseases, especially bronchitis, emphysema, and asthma increased mortality SMR = 1.5 (95% CI = 1.1-2.2) in UC. Cerebrovascular disease mortality occurred less often than expected (SMR = 0.7; 95% CI = 0.5-1.0). Mortality for other diseases and groups of diseases was close to that expected.
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Affiliation(s)
- A Ekbom
- Cancer Epidemiology Unit, University Hospital, Uppsala, Sweden
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14
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Weiner SR, Clarke J, Taggart NA, Utsinger PD. Rheumatic manifestations of inflammatory bowel disease. Semin Arthritis Rheum 1991. [DOI: 10.1016/0049-0172(91)90011-n] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Granot E, Rottem M, Rein AJ. Carditis complicating inflammatory bowel disease in children. Case report and review of the literature. Eur J Pediatr 1988; 148:203-5. [PMID: 3215196 DOI: 10.1007/bf00441402] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A 10-year-old child with ulcerative colitis is described who during the quiescent phase of his disease suffered from pericarditis with pleuropericardial effusion. The literature on cardiac involvement in inflammatory bowel disease is reviewed with emphasis on the paediatric age group.
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Affiliation(s)
- E Granot
- Department of Paediatrics, Hadassah University Hospital, Jerusalem, Israel
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