Acute Pericarditis Associated with 5-Aminosalicylic Acid (5-ASA) Treatment for Severe Active Ulcerative Colitis.

Abstract

A 17-year-old male who had been diagnosed with ulcerative colitis was prescribed 80 mgprednisolone and 1,500 mg5-aminosalicylic acid (5-ASA) per day. Two weeks after initiating therapy, he was referred to our hospital for evaluation of chest pain and high fever. Electrocardiography (ECG) showed ST elevation in limb and precordial leads. Chest pain with high fever and ECGchanges were resolved after 5-ASAwas discontinued. Three weeks later, the administration of a low dose of 5-ASAwas associated with the immediate recurrence of pericarditis associated with chest pain, suggesting a hypersensitive reaction to 5-ASA in this patient. (Internal Medicine 40: 901-904, 2001)

5-Aminosalicylic Acid–Associated Myocarditis and Pericarditis: A Narrative Review

“…The patients described in these reports frequently, but not inevitably, presented with fever (Table 1), chest pain, 3,[6][7][8]11,[13][14][15][16][17]19,23,24,27,30,31,[36][37][38]40,[44][45][46][48][49][50]52,53 and shortness of breath. 7,16,17,24,29,30,32,36,46,52 The symptom of lassitude or fatigue was also common at the time of presentation.…”

“…7,11,17,29,30,43,46,49 Cardiac echocardiography commonly showed the presence of pericardial effusion. [4][5][6][7]12,[15][16][17]20,23,24,26,27,29,37,42,44,52 If the pericardial effusion was sufficiently large, cardiac tamponade Table 1 This single copy is for your personal, non-commercial use only. For permission to reprint multiple copies or to order presentation-ready copies for distribution, contact CJHP at cjhpedit@cshp.ca Table 1 was sometimes noted.…”

“…For permission to reprint multiple copies or to order presentation-ready copies for distribution, contact CJHP at cjhpedit@cshp.ca Table 1 was sometimes noted. 5,6 The extent of the myocarditis was sometimes indicated by depressed contractility 8,13,27,31,32,40,43,44,48,50 shown by echocardiography. There is no pathognomonic laboratory test that can prove the presence of 5-ASA toxicity.…”

“…Eosinophilia has sometimes been noted in the leukocyte differential analysis. 6,25,33,37,42,44,53 Evidence of inflammation was frequently indicated by elevation of the erythrocyte sedimentation rate (Table 1) [13][14][15]27,30,32,36,38,40,43,46,[48][49][50][51] Elevated N-terminal pro-brain natriuretic peptide concentrations have also been found. 42,44 The presence or absence of any or all of the above symptoms and signs does not confirm the role of 5-ASA in the origin of the condition.…”

Severe chest pain in a pediatric ulcerative colitis patient after 5-aminosalicylic acid therapy

“…Cardiac complications have been reported as a rare extraintestinal manifestation of inflammatory bowel disease (IBD) and mainly manifest as pericarditis [2][3][4] . However, cardiac complications may be associated as a very rare drug reaction to 5-aminosalicylic acid (5-ASA) products [1,5,6] . The difficulty lies in distinguishing between these two etiologies.…”