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1
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Bhardwaj A, Singh A, Midha V, Sood A, Wander GS, Mohan B, Batta A. Cardiovascular implications of inflammatory bowel disease: An updated review. World J Cardiol 2023; 15:553-570. [PMID: 38058397 PMCID: PMC10696203 DOI: 10.4330/wjc.v15.i11.553] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 10/22/2023] [Accepted: 11/08/2023] [Indexed: 11/23/2023] Open
Abstract
Emerging data highlights the heightened risk of atherosclerotic cardiovascular diseases (ASCVD) in patients with chronic inflammatory disorders, particularly those afflicted with inflammatory bowel disease (IBD). This review delves into the epidemiological connections between IBD and ASCVD, elucidating potential underlying mechanisms. Furthermore, it discusses the impact of current IBD treatments on cardiovascular risk. Additionally, the cardiovascular adverse effects of novel small molecule drugs used in moderate-to-severe IBD are investigated, drawing parallels with observations in patients with rheumatoid arthritis. This article aims to comprehensively evaluate the existing evidence supporting these associations. To achieve this, we conducted a meticulous search of PubMed, spanning from inception to August 2023, using a carefully selected set of keywords. The search encompassed topics related to IBD, such as Crohn's disease and ulcerative colitis, as well as ASCVD, including coronary artery disease, cardiovascular disease, atrial fibrillation, heart failure, conduction abnormalities, heart blocks, and premature coronary artery disease. This review encompasses various types of literature, including retrospective and prospective cohort studies, clinical trials, meta-analyses, and relevant guidelines, with the objective of providing a comprehensive overview of this critical intersection of inflammatory bowel disease and cardiovascular health.
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Affiliation(s)
- Arshia Bhardwaj
- Department of Gastroenterology, Dayanand Medical College and Hospital, Punjab, Ludhiana 141001, India
| | - Arshdeep Singh
- Department of Gastroenterology, Dayanand Medical College and Hospital, Punjab, Ludhiana 141001, India
| | - Vandana Midha
- Department of Internal Medicine, Dayanand Medical College and Hospital, Punjab, Ludhiana 141001, India
| | - Ajit Sood
- Department of Gastroenterology, Dayanand Medical College and Hospital, Punjab, Ludhiana 141001, India
| | - Gurpreet Singh Wander
- Department of Cardiology, Dayanand Medical College and Hospital, Punjab, Ludhiana 141001, India
| | - Bishav Mohan
- Department of Cardiology, Dayanand Medical College and Hospital, Punjab, Ludhiana 141001, India
| | - Akash Batta
- Department of Cardiology, Dayanand Medical College and Hospital, Punjab, Ludhiana 141001, India.
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2
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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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3
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Jena A, Singh AK, Siddharda BV, Panda P, Sharma V. Mesalamine-Induced Perimyocarditis: Rare Adverse Event in a Patient With Acute Severe Ulcerative Colitis. Inflamm Bowel Dis 2022; 28:e66-e67. [PMID: 34757426 DOI: 10.1093/ibd/izab288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Anuraag Jena
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, Indiaand
| | - Anupam Kumar Singh
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, Indiaand
| | - Bikkina Venkat Siddharda
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, Indiaand
| | - Prashant Panda
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, Indiaand
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4
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Das BB, Dodson M, Guzman A. Recurrent pericarditis in an adolescent with Crohn's colitis. Ann Pediatr Cardiol 2020; 13:256-259. [PMID: 32863666 PMCID: PMC7437634 DOI: 10.4103/apc.apc_16_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/17/2020] [Accepted: 04/24/2020] [Indexed: 12/16/2022] Open
Abstract
Extraintestinal manifestations are common complications of inflammatory bowel disease (IBD), whereas the recurrent pericarditis during remission of Crohn's disease is rarely reported. Chest pain developed in a 13-year-old adolescent male who had a history of Crohn's colitis since 9 years of age and was in remission for 4 years after treatment with infliximab, adalimumab, and vedolizumab. Physicians should be aware of the pericardial involvement in patients with a history of IBD. The literature on pericardial involvement in Crohn's disease is reviewed with emphasis on the management of recurrent pericardial effusion in the pediatric age group.
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Affiliation(s)
- Bibhuti B Das
- Division of Pediatric Cardiology, Texas Children's Hospital, Austin Specialty Care, Austin, Texas, USA
| | - Morgan Dodson
- Division of Pediatric Cardiology, Texas Children's Hospital, Austin Specialty Care, Austin, Texas, USA
| | - Angel Guzman
- Division of Pediatric Cardiology, Texas Children's Hospital, Austin Specialty Care, Austin, Texas, USA
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5
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Mitchell NE, Harrison N, Junga Z, Singla M. Heart Under Attack: Cardiac Manifestations of Inflammatory Bowel Disease. Inflamm Bowel Dis 2018; 24:2322-2326. [PMID: 29788235 DOI: 10.1093/ibd/izy157] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Indexed: 12/12/2022]
Abstract
There is a well-established association between chronic inflammation and an elevated risk of heart disease among patients with systemic autoimmune conditions. This review aims to summarize existing literature on the relationship between inflammatory bowel disease and ischemic heart disease, heart failure, arrhythmia, and pericarditis, with particular attention to approaches to management and treatment.
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Affiliation(s)
- Natalie E Mitchell
- Department of Internal Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Nicole Harrison
- Gastroenterology Service , Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Zachary Junga
- Gastroenterology Service , Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Manish Singla
- Gastroenterology Service, Walter Reed National Military Medical Center, Bethesda, Maryland.,Department of Internal Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland
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6
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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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7
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Bernardo S, Fernandes SR, Araújo-Correia L. Mesalamine-induced myopericarditis - A case report. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2017; 108:753-756. [PMID: 26876057 DOI: 10.17235/reed.2016.4016/2015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Myopericarditis has occasionally been reported as a side effect of mesalamine in patients with inflammatory bowel disease. We present a 20-year-old woman with ulcerative colitis admitted with chest pain. After thorough investigation she was diagnosed with myopericarditis potentially related to mesalamine. There was complete clinical and laboratorial recovery following drug withdrawal. Although uncommon, the possibility of myopericarditis should be considered in patients with inflammatory bowel disease presenting with cardiac complaints. Early recognition can avoid potential life-threatening complications.
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Affiliation(s)
- Sónia Bernardo
- Serviço de Gastrenterologia e Hepatologia, Hospital Santa Maria, Portugal
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8
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Brown G. 5-Aminosalicylic Acid-Associated Myocarditis and Pericarditis: A Narrative Review. Can J Hosp Pharm 2016; 69:466-472. [PMID: 28123193 PMCID: PMC5242279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Use of medications containing the 5-aminosalicylic acid (5-ASA) moiety may cause a rare but potentially lethal side effect involving inflammation of the heart (myocarditis) or pericardium (pericarditis) or both (myopericarditis). Early recognition of 5-ASA as the cause is important to prevent progression of the inflammation. OBJECTIVE To provide clinicians with information to assist in recognizing the signs and symptoms of 5-ASA-induced cardiac inflammation and the characteristics of the suspected therapy, and in determining the appropriate approach to treatment. DATA SOURCES STUDY SELECTION AND DATA EXTRACTION The Embase database was searched, for the period 1974 to July 17, 2015, for published descriptions of cases of cardiac inflammation caused by 5-ASA-containing medications. The search terms included the names of specific agents, as well as terms for different types of cardiac inflammation. Articles in any language were retained for inclusion in this narrative review. FINDINGS There is no symptom, sign, laboratory test, or constellation of symptoms and signs that is pathognomonic for 5-ASA-induced myocardial-pericardial toxicity. Similarly, there is no single laboratory, electrocardiographic, or echocardiographic finding or combination of findings that implicates 5-ASA as the cause of nonspecific symptoms. However, most patients present with chest pain, shortness of breath, and fever within the first 28 days after initiating 5-ASA. Physical examination, electrocardiography, and diagnostic imaging will yield findings consistent with myocarditis, with or without accompanying pericarditis. Prompt discontinuation of the 5-ASA will result in resolution of symptoms within days, without the need for any adjunctive therapies. Rechallenge with any 5-ASA-containing compound carries a high risk for recurrence of the inflammation. CONCLUSIONS Any patient presenting with chest pain, shortness of breath, or fever within 28 days after initiating a 5-ASA-containing drug should be considered as exhibiting drug-induced inflammation. The 5-ASA-containing drug should be stopped immediately until other causes can be proven (or excluded); if no other cause is discovered, the 5-ASA should not be restarted.
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Affiliation(s)
- Glen Brown
- Address correspondence to: Dr Glen Brown, Pharmacy, St Paul’s Hospital, 1081 Burrard Street, Vancouver BC V6Z 1Y6, e-mail:
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9
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Ferrusquía J, Pérez-Martínez I, Gómez de la Torre R, Fernández-Almira ML, de Francisco R, Rodrigo L, Riestra S. Gastroenterology case report of mesalazine-induced cardiopulmonary hypersensitivity. World J Gastroenterol 2015; 21:4069-4077. [PMID: 25852295 PMCID: PMC4385557 DOI: 10.3748/wjg.v21.i13.4069] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 11/27/2014] [Accepted: 01/21/2015] [Indexed: 02/06/2023] Open
Abstract
Mesalazine is a 5-aminosalicylic acid derivative that has been widely used to treat patients with inflammatory bowel disease. Accumulating evidence indicates that mesalazine has a very low rate of adverse drug reactions and is well tolerated by patients. However, a few cases of pulmonary and cardiac disease related to mesalazine have been reported in the past, though infrequently, preventing clinicians from diagnosing the conditions early. We describe the case of a 32-year-old man with ulcerative colitis who was admitted with a two-month history of persistent fever following mesalazine treatment initiated 14 mo earlier. At the time of admission, mesalazine dose was increased from 1.5 to 3.0 g/d, and antibiotic therapy was started with no improvement. Three weeks after admission, the patient developed dyspnea, non-productive cough, and chest pain. Severe eosinophilia was detected in laboratory tests, and a computed tomography scan revealed interstitial infiltrates in both lungs, as well as a large pericardial effusion. The bronchoalveolar lavage reported a CD4/CD8 ratio of 0.5, and an increased eosinophil count. Transbronchial biopsy examination showed a severe eosinophilic infiltrate of the lung tissue. Mesalazine-induced cardiopulmonary hypersensitivity was suspected after excluding other possible etiologies. Consequently, mesalazine treatment was suspended, and corticosteroid therapy was initiated, resulting in resolution of symptoms and radiologic abnormalities. We conclude that mesalazine-induced pulmonary and cardiac hypersensitivity should always be considered in the differential diagnosis of unexplained cardiopulmonary symptoms and radiographic abnormalities in patients with inflammatory bowel disease.
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10
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Kiyomatsu H, Kawai K, Tanaka T, Tanaka J, Kiyomatsu T, Nozawa H, Kanazawa T, Kazama S, Ishihara S, Yamaguchi H, Sunami E, Watanabe T. Mesalazine-induced Pleuropericarditis in a Patient with Crohn's Disease. Intern Med 2015; 54:1605-8. [PMID: 26134190 DOI: 10.2169/internalmedicine.54.4316] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 16-year-old boy was diagnosed with Crohn's disease. Treatment with oral mesalazine was started at 3 g per day; however, he complained of high fever, a nonproductive cough, and left shoulder pain after 2 weeks. His chest radiography and chest computed tomography showed cardiomegaly and left pleural effusion, while an echocardiogram revealed pericardial effusion. Because no infection was detected by thoracentesis and the drug lymphocyte stimulation tests for mesalazine were positive, the patient was diagnosed with mesalazine-induced pleuropericarditis. After the cessation of mesalazine, the clinical symptoms and laboratory findings quickly improved.
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Affiliation(s)
- Hidemichi Kiyomatsu
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Japan
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11
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12
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Calafat M, Mañosa M, Cabré E, Domènech E. [Acute pericarditis associated with oral or topical mesalazine therapy in patients with ulcerative colitis]. GASTROENTEROLOGIA Y HEPATOLOGIA 2013; 37:254-5. [PMID: 24333139 DOI: 10.1016/j.gastrohep.2013.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 09/12/2013] [Indexed: 01/29/2023]
Affiliation(s)
- Margalida Calafat
- Servei d'Aparell Digestiu, Hospital Universitari Germans Trias i Pujol, CIBER de Enfermedades Hepáticas y Digestivas, Badalona, España
| | - Míriam Mañosa
- Servei d'Aparell Digestiu, Hospital Universitari Germans Trias i Pujol, CIBER de Enfermedades Hepáticas y Digestivas, Badalona, España.
| | - Eduard Cabré
- Servei d'Aparell Digestiu, Hospital Universitari Germans Trias i Pujol, CIBER de Enfermedades Hepáticas y Digestivas, Badalona, España
| | - Eugeni Domènech
- Servei d'Aparell Digestiu, Hospital Universitari Germans Trias i Pujol, CIBER de Enfermedades Hepáticas y Digestivas, Badalona, España
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13
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Qanneta R, García Pardo G, Florit Serra L. Acute pleuropericarditis in a patient with primary Sjögren's syndrome and quiescent ulcerative colitis in longstanding 5-aminosalicylic acid therapy. J Crohns Colitis 2013; 7:e506-7. [PMID: 23768863 DOI: 10.1016/j.crohns.2013.05.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 05/23/2013] [Indexed: 02/08/2023]
Affiliation(s)
- Rami Qanneta
- Department of Internal Medicine, Hospital Viamed Monegal, Tarragona, Spain.
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14
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Sonu I, Wong R, Rothenberg ME. 5-ASA induced recurrent myopericarditis and cardiac tamponade in a patient with ulcerative colitis. Dig Dis Sci 2013; 58:2148-50. [PMID: 23361575 DOI: 10.1007/s10620-013-2566-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 01/04/2013] [Indexed: 02/07/2023]
Affiliation(s)
- Irene Sonu
- Department of Medicine, Stanford University Medical Center, Stanford, CA 94305, USA
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15
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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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16
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Park EH, Kim BJ, Huh JK, Jeong EH, Lee SH, Bang KB, Seol JS, Sung JW, Kim BS, Kang JH. Recurrent mesalazine-induced myopericarditis in a patient with ulcerative colitis. J Cardiovasc Ultrasound 2012. [PMID: 23185660 PMCID: PMC3498314 DOI: 10.4250/jcu.2012.20.3.154] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Inflammatory bowel disease (IBD) is considered as a dysregulated immune mediated disease. Pericarditis in IBD is a very rare disease both as an extra-intestinal manifestation of IBD and an adverse reaction of therapeutic drug for IBD such as mesalazine or sulfasalazine. A 26-year-old IBD male patient who had been taking mesalazine regularly for about 1 month was referred to our hospital because of fever, chest discomfort, and abnormal electrocardiographic findings. The patients was diagnosed as acute myopericarditis, and recovered after cessation of mesalazine using steroid and aspirin. When mesalazine was re-medicated some days after discharge, he suffered from myopericarditis again. Subsequently, myopericarditis was resolved just after cessation of mesalazine again. These findings suggest that the development of myopericarditis is caused by mesalazine.
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Affiliation(s)
- Eun Hye Park
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Abstract
A 26-year-old man with ulcerative colitis was independently evaluated in different emergency rooms on two occasions, separated by six years, for episodes of severe chest pain consistent with myopericarditis. Cardiac enzyme and electrocardiographic changes were accompanied by extensive colonic inflammatory changes. Treatment with corticosteroids led to resolution. While his cardiac findings were initially believed to be caused by a previously reported drug hypersensitivity to mesalamine (5-aminosalicylate), sulphasalazine was tolerated. Recurrent myopericarditis with ulcerative colitis appears to be rare, but responsive to steroids. It may occur more often than is currently appreciated and may lead to fatal arrhythmias or cardiac failure.
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Affiliation(s)
- Hugh James Freeman
- Department of Medicine, University of British Columbia, Vancouver, British Columbia.
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18
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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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19
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Sierra Ausín M, Rascarachi G, Díez Rodríguez R, Arias Rodríguez L, Del Pozo Maroto E, Muñoz Núñez F. [Mesalazine-induced acute pericarditis]. GASTROENTEROLOGIA Y HEPATOLOGIA 2010; 33:338-9. [PMID: 20005014 DOI: 10.1016/j.gastrohep.2009.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2009] [Revised: 10/27/2009] [Accepted: 10/28/2009] [Indexed: 12/21/2022]
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20
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Seow CH, de Silva S, Kaplan GG, Devlin SM, Ghosh S, Panaccione R. Managing the risks of IBD therapy. Curr Gastroenterol Rep 2010; 11:509-17. [PMID: 19903428 DOI: 10.1007/s11894-009-0077-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Successful management of the patient with inflammatory bowel disease (IBD) involves not only the induction and maintenance of remission, but also the optimization of the benefit-to-risk equation to achieve the greatest gain in quality of life. These risks range from intolerance to prescribed medications to potentially life-threatening sequelae (eg, sepsis) of immune suppression. A proper awareness of risk on the part of the physician and education of the patient can lead to early detection and institution of an appropriate management plan, including risk management and, optimally, primary prevention (eg, prophylactic vaccination). One should take the opportunity regularly to reassess the utility and efficacy of existing therapy, with the provision of ineffective therapies mandating urgent review. Overall, optimal management of the patient with IBD requires open dialogue between clinician and patient so that both are cognizant of the goals, benefits, and potential risks of therapy.
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Affiliation(s)
- Cynthia H Seow
- University of Calgary, TRW Building, Room 6D18, Calgary, Canada.
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21
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Acute perimyocarditis mimicking transmural myocardial infarction. Int Arch Med 2009; 2:37. [PMID: 20003228 PMCID: PMC3225872 DOI: 10.1186/1755-7682-2-37] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2009] [Accepted: 12/09/2009] [Indexed: 11/10/2022] Open
Abstract
Although acute pericarditis has charachteristic electrocardiographic (ECG) findings that differentiate it from acute ST segment elevation myocardial infarction (MI); in certain cases diagnosis is somewhat difficult especially when the ECG reveals focal instead of diffuse changes and moreover when pericarditis is associated with an underlying myocarditis causing elevation of the cardiac biomarkers therefore increasing the difficulty in differentiating between both enteties. This is especially important because adverse lethal side effect can occur if thrombolytic therapy is administered for a patient with acute pericarditis, or if a diagnosis of transmural MI is missed. In this case report we are describing an 18 year old male patient who presented with an acute onset of severe chest pain associated with focal ECG changes and elevated cardiac enzymes mimicking transmural MI. This report aims to sensitize readers to this debate and create awareness among cardiologists and intensivists with both presentations and how to reach an accurate diagnosis.
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Martín M, Santamarta E, de la Iglesia JM, Saiz A. [Myopericarditis in a patient with ulcerative colitis treated with mesalazine]. Med Clin (Barc) 2009; 134:43-4. [PMID: 19423137 DOI: 10.1016/j.medcli.2009.02.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Accepted: 02/17/2009] [Indexed: 01/06/2023]
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Abstract
As systemic immunological disorders, internal diseases in gastroenterology, rheumatology and infectiology can, in addition to the bowels, potentially involve the musculo-skeletal system, the immunological system and heart structures. All structures and functions of the heart can be affected. Pericarditis in lupus erythematosus and chronic inflammatory bowel disease, myocarditis in HIV infection and lyme disease are examples of cardiac manifestations of internal diseases. The pathogenetic causes can be manifold, such as direct cytotoxic effects in HIV or Borrelia burgdorferi infections, induced vasculitis and local activation of coagulation factors as in lupus erythematosus or chronic inflammatory bowel disease. Improved treatment options have led to more long-lasting courses of internal diseases, such as in infectious diseases, lupus erythematosus and chronic inflammatory bowel disease, thus cardiovascular complications such as pericarditis and myocarditis gain increasing importance as a consequence of chronic disease and therapy-related damage.
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Lê Quang C, Kouzez M, Welsch C, Ravan R, Ferrier N, Cassan P, Marcaggi X, Amat G. [Myocarditis or subendocardial myocardial infarction: role of MRI illustrated by a case report]. Ann Cardiol Angeiol (Paris) 2008; 57:307-310. [PMID: 18930179 DOI: 10.1016/j.ancard.2008.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2008] [Accepted: 08/27/2008] [Indexed: 05/26/2023]
Abstract
A 50-year-old male patient treated with mesalazine for Crohn's disease was admitted in our unit for a chest pain, associated with nonspecific ST depression or ECG and troponin elevation. Coronarography showed minimal changes while SPECT imagery suggested a posterobasal subendocardial infarction, so that the diagnosis was unclear between ischemic disease and mesalazine-induced myocarditis. Eventually, MRI demonstrated clearly a subendocardial posterior infarction eliciting the diagnosis of mesalazine-induced myocarditis. This case report illustrates, in our opinion, that MRI is of invaluable interest in evaluating the characteristics of myocardium, and must be the cornerstone in the diagnosis of myocardial diseases.
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Affiliation(s)
- C Lê Quang
- Service de cardiologie, centre hospitalier de Vichy, boulevard Denière, 03200 Vichy, France
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John Wiley & Sons, Ltd.. Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2006. [DOI: 10.1002/pds.1183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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