Myocarditis as an extraintestinal manifestation of ulcerative colitis: A case report and review of the literature

Table 1 Summary of reported cases describing myocarditis as an extraintestinal manifestation of inflammatory bowel disease

Ref.	Sex/age	IBD type	Diagnosis	Clinical presentation	Testing	Myocarditis treatment	Outcome	Recurrence/other info
Frid et al[22], 1986	Male/11	CD	Myocarditis	Fever (38 °C), fatigue, dyspnea on exertion	Raised ESR; ST-segment depression (ECG)	Steroids	Improved	EIM earlier than GI symptoms
Weiss et al[23], 1995	Male/44	CD	Myocarditis	Fatigue, dyspnea on exertion symptoms of congestive heart failure	WBC 15.2, ESR 64, CRP 64.2; ST-T segment flattening (ECG); cardiomegaly (CXR); LVEF 30%, left heart enlargement with regional hypokinesia (echo)	Steroids + olsalazine	Improved	Subcutaneous granulomas; EIM earlier than GI symptom
Hyttinen et al[24], 2003	Female/37	CD	Myopericarditis	Chest pain, palpitations, dyspnea on exertion loss of consciousness, convulsions	CRP 149; third-degree AV block, ST-segment elevation T-wave inversion (ECG); pericardial effusion (echo); normal (EMB)	Atropine + PPM	Improved	5 × recurrences; GI symptom (-)
Nishtar et al[25], 2009	Female/21	CD	Myocarditis	Fever (37.5 °C), dyspnea, symptoms of pulmonary edema, hemodynamically unstable	WBC 21, CRP 234; TnI 0.48; diffuse T-wave inversion (ECG); pulmonary edema (CXR); LVEF 16%, dilation of ventricles with global hypokinesia (echo)	ICU + ventilatory and inotropic support mesalamine	Improved	After limited hemicolectomy
Sikkens et al[26], 2010	Male/46	CD	Myopericarditis	Fever (38.5 °C), tachypnea cardiac arrest	WBC 12, ESR 22; unremarkable ventricular fibrillation (ECG); lymphocytic infiltration (autopsy)	CPR	Died
Williamson and Dalton[27], 2011	Male/18	CD	Myocarditis	Shock, tachypnea, hypoxic	Raised CRP; pulmonary edema (CXR); RBBB LVEF 20%, LV failure (echo)	Subtotal colectomy + ventilatory and inotropic support	Improved
Oh et al[28], 2012	Female/19	CD	Myocarditis	Fever (41.0 °C), headache, myalgia impaired consciousness, shock, respiratory failure	WBC 21.44, CRP 92.9; TnI 5.32; sinus tachycardia (ECG); pulmonary edema (CXR); LVEF 38%, dilation of ventricles with LV regional akinesia (echo)	ICU + inotropic support steroid + mesalamine	Improved
Belin et al[29], 2016	Female/56	CD	Myocarditis	Pleuritic chest pain radiating to the back and shoulders	WBC 13.7, ESR 47, CRP 22.7; TnI 1.14-1.63, BNP 166; LV hypertrophy (ECG); pleural effusion (CXR); LVEF 45-50%, regional hypokinesia (scho); regional DGE, elevated ECV (CMR)	Infliximab steroids	Improved
Kumar et al[30], 2019	Male/37	CD	Myopericarditis	Pleuritic chest pain, dry cough, fever (38.1 °C)	WBC 26.2, ESR 121, CRP 180.1; TnI 1.82; ST-segment elevation (ECG); regional EGE and DGE with edema (CMR)	Steroids + colchicine	Improved	P.M. stress cardiomyopathy
McGrath-Cadell et al[31], 2020	Female/27	CD	Myopericarditis	Pleuritic chest pain, fever (39 °C), dyspnea, hemodynamically unstable	WBC 21, CRP 115; TnI 9; T-wave inversion (ECG); regional thickening and hypokinesia, mobile valvular masses (echo); focal edema with DGE (CMR)	Steroids + colchicine + AZA	Improved	2 × recurrences; P.M. monocular visual loss and sterile splenic abscesses; GI symptoms (-)
Mowat et al[32], 1974	Male/15	UC	Myopericarditis	Retrosternal discomfort, fever	Raised ESR; sinus tachycardia, ST-segment abnormality, T-wave inversion (ECG)	Steroids + sulphasalazine	Improved	4 × recurrences; renal calculus
McKeon et al[33], 1986	Female/17	UC	Myocarditis	Cardiac arrest, hypotensive, peripheral edema	Pleural effusion (CXR); sinus tachycardia with incomplete RBBB tachyarrhythmias (ECG); LVEF 23%, RV dilation (echo); giant cell collection (autopsy)	ICU + inotropic support	Died	After total colectomy, PTN
Frid et al[22], 1986	Male/19	UC	Myocarditis	Fatigue, dyspnea heart failure, arrythmia	ESR 10; cardiomegaly, pleural effusion (CXR); heart little movement (echo)	ICU + steroids	Improved	Urticaria; GI symptoms (-)
Stajer and Gorjup[34], 1996	Female/17	UC	Myopericarditis	Chest pain, tachycardia, dyspnea, hypotensive, hypoxic, enlarged liver and spleen	ESR 72; S1Q3, R-wave progression (ECG); cardiomegaly, bilateral effusion (CXR); pericardial effusion, RV enlargement (echo)	ICU + mesalamine	Improved	Pleuritis, DVT
Nash et al[35], 2001	Male/46	UC	Myocarditis	Chest pain, tachycardia, hypotensive, tachypnea; gallop rhythm, hepatojugular reflux (+)	WBC 18.6; ST-segment elevation (ECG); LVEF 19%, global hypokinesia (echo); giant cells with necrosis (EMB)	ICU + inotropic support + IABP + steroids + immunoglobulin + CsA + etanercept + AZA	Died	P.M. ITP
Freeman and Salh[36], 2010	Male/26	UC	Myopericarditis	Pleuritic chest pain radiating to the shoulder and neck, fever, tachycardia, lethargy	WBC normal; TnI 4.82; atrial flutter with 2:1 block non-specific ST-T wave change (ECG)	Steroids + mesalamine	Improved	2 × recurrences, EIM before GI symptoms
Varnavas et al[37], 2014	Male/30	UC	Myocarditis	Symptoms of left heart failure	WBC 16.3, CRP 276; TnI 7.6, BNP 4745; sinus tachycardia, non-specific ST-T wave changes (ECG); LVEF 13%, regional hypokinesia, pericardial effusion (echo); focal edema (CMR); lymphocytic infiltration (EMB)	ICU + inotropic support + IABP + steroids + mesalamine	Improved	2 × recurrences
Gruenhagen et al[38], 2014	Male/24	UC	Myocarditis	Chest pain radiating to the arms, dyspnea, diaphoresis, dizziness	TnI 0.211-1.57 (ref < 0.034); ST-segment elevation (ECG); DGE (CMR)	Ssteroid + mesalamine	Improved
Kim et al[39], 2016	Female/28	UC	Myocarditis	Dyspnea	TnI 0.512; sinus tachycardia, non-specific ST-segment change (ECG); cardiomegaly, pulmonary congestion (CXR); LVEF 33%, LV hypokinesia and dilation (echo)	ECMO + steroid + infliximab	Improved
Murphy et al[40], 2017	Male/42	UC	Myocarditis	Symptoms of heart failure	BNP 4987; non-specific T-wave changes (ECG); pulmonary edema, pleural effusion (CXR); LVEF 29%, LV global hypokinesia, pericardial effusion (echo); focal DGE (CMR); eosinophilic infiltration, fibrosis (EMB)	Steroids + ICD	Improved
Caio et al[41], 2021	Male/26	UC	Myocarditis	Chest pain, tachycardia	WBC 15.2, CRP 32.1; raised TnI; normal (ECG); focal edema (CMR)	Steroids + vedolizumab	Improved	2 × recurrences

CD: Crohn’s disease; UC: Ulcerative colitis; WBC: White blood cell (× 10⁹/L); CRP: C-reactive protein; ESR: Erythrocyte sedimentation rate; TnI: Cardiac troponin I; BNP: Brain natriuretic peptide; ECG: Electrocardiogram; RBBB: Right bundle branch block; CXR: Chest radiograph; echo: Echocardiography; LVEF: Left ventricular ejection fraction; CMR: Cardiovascular magnetic resonance; EGE: Early gadolinium enhancement; DGE: Delayed gadolinium enhancement; ECV: Extracellular volume; EMB: Endomyocardial biopsy; PPM: Permanent pacemaker; ICD: Implantable cardioverter-defibrillator; IABP: Intra-aortic balloon pump; AZA: Azathioprine; CsA: Cyclosporin A; CPR: Cardiac pulmonary resuscitation; GI symptoms: Gastrointestinal symptoms; EIM: Extraintestinal manifestation; ITP: Immune thrombocytopenic purpura; DVT: Deep venous thrombosis; TPN: Total parenteral nutrition; IBD: Inflammatory bowel disease; ICU: Intensive care unit; P.M.: Past medical history.