Mesalamine-induced myopericarditis - A case report

Bernardo, Sónia; Araújo-Correia, Luís

doi:10.17235/reed.2016.4016/2015

Cited by 6 publications

(4 citation statements)

References 12 publications

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“…Many proposed theories about mesalamine-induced pericarditis include direct cytotoxic damage and humoral or cell-mediated mechanisms [3]. The most common theory is a humoral-mediated hypersensitivity reaction, in which antibodies against mesalamine cross-react with cardiac tissue leading to inflammation [6,[8][9][10].…”

Section: Discussionmentioning

confidence: 99%

Achy Breaky Heart: A Rare Case of Myopericarditis Secondary to Mesalamine in a Patient With Inflammatory Bowel Disease

Appala,

Veeramachaneni,

Khare

et al. 2024

Cureus

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Mesalamine is a first-line drug used in the treatment of inflammatory bowel disease (IBD), specifically ulcerative colitis (UC), with side effects ranging from gastrointestinal effects to cardiotoxicity. We present a rare case of mesalamine-induced myopericarditis in a patient with IBD, who presented with epigastric pain and was found to have elevated an c-reactive protein (CRP) in the absence of chest pain and any other gastrointestinal symptoms. This case highlights the importance of including myopericarditis as a differential for IBD patients on mesalamine with an isolated elevated CRP, especially within the first month of initiating this medication, as drug cessation usually leads to immediate clinical improvement.

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Section: Discussionmentioning

confidence: 99%

Achy Breaky Heart: A Rare Case of Myopericarditis Secondary to Mesalamine in a Patient With Inflammatory Bowel Disease

Appala,

Veeramachaneni,

Khare

et al. 2024

Cureus

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“…Analysis: Pericarditis arising due to 5-ASA derivatives have various pathological mechanisms. Mitchell et al and Bernardo et al suggest that an IgE-mediated hypersensitivity reaction may be responsible [15,16]. Direct cardiotoxicity has also been proposed where 5-ASA derivatives directly damage myocytes, exposing antigens and releasing inflammatory mediators, with the latter eliciting an immune response [17].…”

Section: Pathogenesismentioning

confidence: 99%

“…The humoral antibody theory, where antibodies are generated against pericardial antigens due to 5-ASA drug exposure, is considered to be one of the most plausible explanations. Owing to sulfasalazine or mesalamine intake, antibodies are generated against pericardial antigens leading to inflammation [16][17][18][19][20][21]. Patients taking sulfasalazine who develop pericarditis are thought to have developed a lupus-like reaction [22][23][24].…”

Section: Pathogenesismentioning

confidence: 99%

Cardiovascular Manifestations in Inflammatory Bowel Disease: A Systematic Review of the Pathogenesis and Management of Pericarditis

Patel

Reddy

Llukmani

et al. 2021

Cureus

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Inflammatory bowel disease (IBD) is a chronic condition of the bowel that can be further categorized into ulcerative colitis and Crohn's disease. Rarely, this condition can be associated with pericarditis, which can be an extraintestinal manifestation of the disease or drug-induced. This review aims to determine the pathogenesis and management of pericarditis in IBD. In this review, the goal is to elucidate the pathogenesis of pericarditis in IBD and determine if pericarditis is an extraintestinal manifestation of IBD or a complication of current drug therapy used to manage IBD. Additionally, this review intends to explain the first-line management of pericarditis in IBD and explore the role of biologicals in attenuating pericarditis. An electronic search was conducted to identify relevant reports of pericarditis in IBD, and a quality assessment was conducted to identify high-quality articles according to the inclusion criteria. Full-text articles from inception to November 2020 were included, while non-English articles, gray literature, and animal studies were excluded. The majority of studies suggest that pericarditis arises as a complication of drug therapy by 5-aminosalicylic acid derivatives such as sulfasalazine, mesalamine, and balsalazide, and it occurs due to IgE-mediated allergic reactions, direct cardiac toxicity, cell-mediated hypersensitivity reactions, and humoral antibody response to therapy. Drug cessation or the initiation of a corticosteroid regimen seems to be the most effective means of managing pericarditis in IBD due to drug therapy or an extraintestinal manifestation.

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“…If managed appropriately, cardiac dysfunction has been shown to resolve completely with a return to previous baseline function [33,39,[53][54][55][56][57][58].…”

Section: Prognosismentioning

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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Mesalamine-induced myopericarditis - A case report

Cited by 6 publications

References 12 publications

Achy Breaky Heart: A Rare Case of Myopericarditis Secondary to Mesalamine in a Patient With Inflammatory Bowel Disease

Achy Breaky Heart: A Rare Case of Myopericarditis Secondary to Mesalamine in a Patient With Inflammatory Bowel Disease

Cardiovascular Manifestations in Inflammatory Bowel Disease: A Systematic Review of the Pathogenesis and Management of Pericarditis

Mesalazine-Induced Cardiotoxicity

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