Chronic Pericarditis and Pericardial Tamponade Associated with Ulcerative Colitis

Abstract

Unlike other extraintestinal inflammatory manifestations of ulcerative colitis, cardiac involvement is infrequently reported and inadequately characterized, with only 9 previously reported cases of pericardial tamponade associated with inflammatory bowel disease. A 32 year old male with ulcerative colitis, treated with orally administered mesalamine for ten years, developed chronic pericarditis. Extensive clinical and laboratory evaluation failed to find any cause of the pericarditis other than the ulcerative colitis. Although the pericarditis remitted with indomethacin therapy, this medicine had to be discontinued because of a reactivation of ulcerative colitis attributed to this nosteroidal antiinflammatory drug (NSAID). The pericarditis then responded well to high-dose corticosteroid therapy, but the patient represented with chest pain, dyspnea, tachypnea, and engorged neck veins after tapering the corticosteroid therapy. Angiography revealed near equalization of end diastolic pressures in both ventricles, a finding consistent with pericardial tamponade. The patient underwent subtotal pericardiectomy. Thoracotomy revealed a thickened pericardial wall and a large pericardial effusion. The patient's symptoms resolved postpericardiectomy. This case extends the clinical spectrum of pericarditis associated with ulcerative colitis, by describing a case of pericarditis that was chronic, refractory to maintenance medical therapy, caused pericardial tamponade, and was successfully treated by pericardiectomy.

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

“…57 The cardiac symptoms may be present at the time of initial presentation of the IBD [55][56][57][58][59] or may occur years after diagnosis of either Crohn disease 57 or ulcerative colitis. 60 However, the prevalence of myocarditis, pericarditis, or myopericarditis unrelated to 5-ASA in patients with IBD is very low. Only 100 cases of pericarditis associated with ulcerative colitis had been published by 2008.…”

“…Only 100 cases of pericarditis associated with ulcerative colitis had been published by 2008. 60 The relative risk of myocarditis compared with the general population has been described as 8.3 for patients with Crohn disease and 2.6 for those with ulcerative colitis. 59 However, because the incidence of any of these conditions is very low in the general population, they will occur infrequently in patients with IBD.…”

“…However, for patients who are taking a 5-ASA product, it is possible that the symptoms represent a flare of the IBD. 60 Unfortunately, there is no diagnostic strategy that will differentiate the 2 possible causes, other than stopping the 5-ASA product and monitoring for potential resolution of symptoms.…”

Extraintestinal Manifestations of Ulcerative Colitis

“…Both acute and chronic pericarditis with and without cardiac tamponade have been reported (Cappell & Turkieh, 2008;Dubowitz & Gorard, 2001). Drug induced pericarditis typically resolves after omission of the offending drug and treatment with NSAIDs is effective.…”

“…Cardiac tamponade is a rare, but life threatening complication of UC that can be diagnosed by echocardiogram or cardiac catheterization. Treatment includes emergent pericardiocentesis and pericardiectomy is indicated for recurrent pericardial effusion and chronic constrictive pericarditis (Cappell & Turkieh, 2008;Rezaie et al, 2010).…”