Cardiac MRI-confirmed mesalamine-induced myocarditis

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.

Systematic review: safety of mesalazine in ulcerative colitis

“…Corticosteroids could be considered to expedite resolution of pericarditis or myocarditis . Re‐challenge with 5‐aminosalicylic acid puts patient at high risk for recurrence of inflammation …”

Mesalamine-Induced Myopericarditis: A Case Report and Literature Review

“…Late or delayed contrast enhancement on cardiac MRI was observed in some cases. However, no consistent pattern was noted [15-18].…”

Mesalamine-induced Myocarditis in a Young Athlete: Can He Run Again?

“…Mesalamine-induced cardiotoxicity has been reported in the literature and is a rare entity. Patients with mesalamine-induced cardiotoxicity can present with dyspnea, substernal chest pain, fever, leucocytosis, elevation in cardiac biomarkers, ST-segment and T-wave abnormalities on EKG and left ventricular systolic dysfunction [2]. The mechanism of mesalamine-induced cardiovascular toxicity remains unclear.…”

“…The use of CMR to confirm the diagnosis of mesalamine-induced cardiotoxicity has been seldom reported [2,5]. Given the potential serious outcomes associated with undiagnosed mesalamine-induced cardiotoxicity, it is essential to acknowledge the presence of such an entity and emphasize that CMR is the diagnostic test of choice.…”

“…Cardiac involvement could be an extra-intestinal manifestation of IBD or a medication side effect. Few cases in the literature have reported cardiotoxicity as a rare possible side effect of mesalamine [2-8]. Patients can present with a wide range of cardiovascular symptoms, ranging from mild chest pain and shortness of breath (SOB) to cardiogenic shock secondary to left ventricular systolic dysfunction [2].…”