Drug points: Fever, vasculitic rash, arthritis, pericarditis, and pericardial effusion after mesalazine

Lim, A G; Hine, K R

doi:10.1136/bmj.308.6921.113

Cited by 33 publications

(7 citation statements)

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“…7,16,17,24,29,30,32,36,46,52 The symptom of lassitude or fatigue was also common at the time of presentation. On physical examination, a pericardial rub 6,12,14,15,20,23,52,53 was sometimes detected, which may have reflected the extent of pericardial involvement. A concurrent pleural rub has been reported, but rarely.…”

Section: What Should Alert the Clinician To The Possibility Of Cardiamentioning

confidence: 99%

“…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.…”

Section: What Should Alert the Clinician To The Possibility Of Cardiamentioning

confidence: 99%

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

Brown

2016

CJHP

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RÉSUMÉContexte : L'emploi de médicaments à base d'acide 5-aminosalicylique (5-AAS) peut causer un effet indésirable rare, mais potentiellement mortel qui se traduit par l'inflammation du myocarde (myocardite) ou du péricarde (péricardite) ou de ces deux éléments du système cardiaque (myopéricardite). Il est important d'établir rapidement que l'inflammation est imputable à l'AAS afin de prévenir la progression de cet effet indésirable. Objectif : Fournir aux cliniciens de l'information les aidant à reconnaître les signes et symptômes d'une inflammation cardiaque causée par le 5-AAS et les caractéristiques de la thérapie soupçonnée ainsi qu'à déterminer l'approche thérapeutique adéquate. Sources des données, sélection des études et extraction des données :La base de données Embase a été interrogée, pour la période allant de 1974 au 17 juillet 2015, afin de trouver des descriptions publiées de cas d'inflammation cardiaque causée par des médicaments contenant du 5-AAS. Les termes utilisés pour la recherche comprenaient les noms d'agents précis ainsi que les termes désignant différents types d'inflammation cardiaque. La langue n'était pas un critère pour l'admissibilité des articles à la présente revue narrative. Résultats : Il n'y a pas de symptôme, de signe, d'examen de laboratoire ou de cortège de symptômes et de signes qui soit pathognomonique d'une toxicité myocardique ou péricardique causée par le 5-AAS. De même, il n'y a pas de résultat de laboratoire, d'électrocardiogramme ou d'échocar-diogramme, seul ou en association, qui puisse attribuer la cause de symptômes non spécifiques au 5-AAS. Cependant, la plupart des patients présentent des douleurs thoraciques, une dyspnée et de la fièvre au cours des 28 premiers jours suivant l'amorce du traitement par le 5-AAS. L'examen physique, l'électrocardiographie et l'imagerie diagnostique permettent d'obtenir des résultats qui indiquent une myocardite, avec ou sans péricardite. L'interruption rapide du traitement par le 5-AAS permet la disparition des symptômes en quelques jours, sans avoir à recourir à un traitement d'appoint. La réintroduction de toute préparation à base de 5-AAS comporte un risque élevé de récurrence de l'inflammation. Conclusions : Tout patient affichant des douleurs thoraciques, de la dyspnée ou de la fièvre dans les 28 jours suivant l'amorce d'un traitement avec une préparation contenant du 5-AAS doit être considéré comme présentant une inflammation causée par un médicament. Il faut interrompre immédiatement le traitement par le 5-AAS jusqu'à ce que d'autres causes puissent être confirmées ou infirmées. Si l'on ne trouve pas d'autre cause aux symptômes, le traitement par le 5-AAS ne doit pas être recommencé.

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Section: What Should Alert the Clinician To The Possibility Of Cardiamentioning

confidence: 99%

Section: What Should Alert the Clinician To The Possibility Of Cardiamentioning

confidence: 99%

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

Brown

2016

CJHP

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“…Nonetheless, 85% to 90% of patients allergic to SASP may tolerate mesalamine preparations (9,11,12). More severe reactions associated with use of mesalamine occur infrequently and include bone marrow suppression (13,14), arthritis (15), pneumonitis (10), pericarditis (15,16), and pancreatitis (17,18).…”

Section: Discussionmentioning

confidence: 99%

Mesalamine Intolerance Mimics Symptoms of Active Inflammatory Bowel Disease

Iofel,

Chawla,

Daum

et al. 2002

J. pediatr. gastroenterol. nutr.

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“…Hypersensitivity is further evidenced by eosinophilic infiltration of the myocardium on myocardial biopsy along with a clear improvement following discontinuation of the drug [19,20]. Hypersensitivity appears to be an idiosyncratic reaction rather than dose dependant phenomenon due to its occurrence in patients on very low doses of mesalazine such as 0.5 gram a day [21,22].…”

Section: Mechanism Of Mesalazine Related Cardiotoxicitymentioning

confidence: 99%

Mesalazine-Induced Cardiotoxicity

Haq¹,

Ahmed²,

Pasha³

et al. 2018

J Rare Disord Diagn Ther

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Background: Inflammatory bowel disease (IBD) which includes ulcerative colitis and Crohn's disease can also affect other organs in the body including heart as extra-intestinal manifestation. Mesalazine is commonly used to treat this chronic inflammatory disorder and is usually well tolerated by most patients. However, there are certain situations where toxic effects of mesalazine involve heart, making it difficult to differentiate between extra-intestinal manifestation and a treatment related complication.Aims/Objective: Main objective of this review was to determine features that can help early recognition of mesalazine-induced cardiac involvement. Moreover, relationship between mesalazine dose and occurrence of cardiotoxicity was also observed. Finally, management of this condition including role of re-challenge in these patients was evaluated.Methods: A literature search for relevant studies of the MEDLINE database was conducted, including reported cases of mesalazine-induced cardiac involvement since 1989.Findings: Mesalazine-induced myopericarditis usually occurs within 2-4 weeks of initial drug exposure but may be delayed due to concomitant steroid use. There does not appear to be a dose-dependent relationship. A clear improvement following discontinuation of the drug helps to make the diagnosis.Mesalazine discontinuation and steroids are successfully used for treatment. Rechallenge usually results in recurrence of cardiac involvement. Cardiac dysfunction resolves completely with a return to previous baseline function. Thiopurines and anti-TNF therapies are used to manage inflammatory bowel disease. Conclusions:It is very important to evaluate any patient presenting with fever, shortness of breath or chest pain within 4 weeks of initiating mesalazine for possible drug-induced inflammation. Mesalazine should be stopped immediately and patient should be treated with steroids. Inflammatory bowel disease should be managed with second line drugs including thiopurines and anti-TNF therapies.

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Drug points: Fever, vasculitic rash, arthritis, pericarditis, and pericardial effusion after mesalazine

Cited by 33 publications

References 1 publication

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

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

Mesalamine Intolerance Mimics Symptoms of Active Inflammatory Bowel Disease

Mesalazine-Induced Cardiotoxicity

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