Recurrent myocarditis in a patient with active ulcerative colitis: a case report and review of the literature

Caio, Giacomo; Lungaro, Lisa; Caputo, Fabio; Muccinelli, Maria; Marcello, Maria Caterina; Zoli, Eleonora; Volta, Umberto; Giorgio, Roberto De; Zoli, Giorgio

doi:10.1136/bmjgast-2020-000587

Cited by 15 publications

(6 citation statements)

References 40 publications

(56 reference statements)

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“…Currently, the COVID-19 disease and its vaccines seem to be contributing to an increased incidence of acute myocarditis [ 2 ]. The disease has also been associated with autoimmune disorders such as sarcoidosis, giant cell arteritis, systemic lupus erythematosus, and ulcerative colitis [ 1 , 5 , 7 ]. Furthermore, drugs and vaccines such as checkpoint inhibitors, smallpox, and COVID mRNA vaccines have been identified as known causes of myocarditis [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

The Masquerading Myocarditis: A Case of Late Recurrence of Acute Myocarditis Presenting as “Peripartum Cardiomyopathy”

Allihien,

Ibrahim,

Agyeman

et al. 2024

Cureus

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Myocarditis is a potentially fatal medical condition with varied etiologies. Peripartum cardiomyopathy (PPCM) refers to systolic dysfunction occurring toward the end of pregnancy or in the months following delivery; it is a diagnosis of exclusion. We present a patient with chest pain, bipedal edema, markedly elevated troponins, electrocardiogram (EKG) findings that were concerning for myocardial infarction, and a significantly reduced left ventricular ejection fraction (LVEF) on the echocardiogram. The patient's presentation in the postpartum period closely resembled peripartum cardiomyopathy and presented a peculiar diagnostic challenge to our team. The right diagnosis was possible with cardiac magnetic resonance imaging, which revealed late gadolinium enhancement. Additionally, the patient had positive Coxsackie B5 and Epstein Bar virus serologies. While the clinical course of the disease is often benign, it could rapidly deteriorate, so early recognition and diagnosis are important to ensure patients receive adequate therapeutic support.

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Section: Discussionmentioning

confidence: 99%

The Masquerading Myocarditis: A Case of Late Recurrence of Acute Myocarditis Presenting as “Peripartum Cardiomyopathy”

Allihien,

Ibrahim,

Agyeman

et al. 2024

Cureus

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“…The onset time of cardiotoxicity for most patients was 2-4 weeks after taking mesalazine, suggesting that we need to pay attention to patients who develop fever, chest pain, and breathing difficulties, especially in the early stages (Radhakrishnan et al, 2018;Shergill, 2021). However, in some patients, the onset of cardiotoxicity was delayed for several months to several years (Okoro et al, 2018;Caio et al, 2021). It is important to note that the onset time does not shorten after increasing the dose of mesalazine, which may indicate Frontiers in Pharmacology frontiersin.org that the onset time is not correlated with the dose (Kaiser et al, 1997;Perez-Colon et al, 2011).…”

Section: Discussionmentioning

confidence: 99%

Analysis of clinical characteristics of mesalazine-induced cardiotoxicity

et al. 2022

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Background: Mesalazine is the first-line inflammatory bowel disease (IBD) treatment. However, it can cause fatal cardiotoxicity. We aimed to analyze the clinical characteristics of mesalazine-induced cardiotoxicity and provide evidence for clinical diagnosis, treatment, and prevention.Methods: We collected Chinese and English literature on mesalazine-induced cardiotoxicity from 1970 to 2021 for retrospective analysis.Results: A total of 52 patients (40 males and 12 females) were included, with a median age of 24.5 years (range 9–62) and a median onset time of 14 days (range 2–2880). Cardiotoxicity manifested as myocarditis, pericarditis, and cardiac pericarditis. The main clinical manifestations are chest pain (82.7%), fever (46.2%), and respiratory symptoms such as dyspnea and cough (40.4%). The levels of troponin T, creatine kinase, C-reactive protein, leukocyte count, erythrocyte sedimentation rate, and other biochemical markers were significantly increased. Cardiac imaging often suggests myocardial infarction, pericardial effusion, myocardial necrosis, and other symptoms of cardiac injury. It is essential to discontinue mesalamine immediately in patients with cardiotoxicity. Although corticosteroids are a standard treatment option, the benefits remain to be determined. Re-challenge of mesalamine should be carefully considered as cardiotoxic symptoms may reoccur.Conclusion: Mesalazine may cause cardiotoxicity in patients with inflammatory bowel disease, which should be comprehensively diagnosed based on clinical manifestations, biochemical indicators, and cardiac function imaging examinations. Mesalazine should be immediately discontinued, and corticosteroids may be an effective treatment for cardiotoxicity.

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“…In den letzten Jahren traten gehäuft Berichte von kardialen Komplikationen im Zusammenhang mit der Diagnose und Therapie einer Colitis ulcerosa auf 9 . Diese standen zumeist im Zusammenhang mit der Gabe von 5-Aminosalicylsäure (5-ASA) und/oder Antikörpern, hier zumeist anti-TNF 4 5 10 11 12 .…”

Section: Diskussionunclassified

Perimyokarditis als Komplikation einer medikamentösen Mehrfachtherapie bei Colitis ulcerosa

Bauer

Baholli

Uflacker

et al. 2022

Dtsch Med Wochenschr

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Zusammenfassung Anamnese und klinischer Befund Stationäre Vorstellung eines 19-jähigen Patienten mit akutem Schub einer Colitis ulcerosa seit ungefähr 6 Wochen und Beschwerdeprogredienz seit anderthalb Wochen. Es bestand eine Therapie mit topischen und oralen 5-Aminosalicylsäure-(5-ASA)-Präparaten sowie eine orale Prednisolon-Gabe. Unter Intensivierung der Prednisolondosis Gabe eines monoklonalen Antikörpers (Vedolizumab) sowie antibiotische Therapie; stationäre Entlassung gegen ärztlichen Rat. Bei weiterhin erhöhten Infektparametern orale Gabe von Ciprofloxacin. Die 5-ASA-Gabe wurde fortgeführt. In den folgenden 2 Wochen rezidivierende Fieberschübe und erneute stationäre Aufnahme. Untersuchungen und Diagnose Mikrobiologischer Nachweis von Acinetobacter ursingii in den Blutkulturen. Echokardiografischer Nachweis eines Perikard-Ergusses. Die transösophageale Echokardiografie ergab keinen Hinweis auf eine infektiöse Endokarditis. Serologischer Nachweis erhöhter Herz-Enzymwerte. Eine MRT-Untersuchung des Herzens bestätigte die Diagnose einer Perimyokarditis. Therapie und Verlauf Intensivmedizinische Betreuung und Resistogramm-gerechte antibiotische Therapie mit Meropenem unter Beendigung der topischen und oralen 5-ASA-Gaben sowie Verzicht auf eine Fortführung der Integrin-Antagonisten-Therapie. Zudem Start einer leitliniengerechten Herzinsuffizienztherapie und Therapieumstellung auf einen Tumor-Nekrose-Faktor-alpha-Blocker. Unter dem akzelerierten Applikationsschema protrahierte Stabilisierung und Besserung des Allgemeinzustandes. Nach 2 Monaten Krankenhausaufenthalt Entlassung des Patienten in die ambulante Versorgung. Diskussion Nach längerfristiger 5-ASA-Gabe ist das Auftreten einer Perimyokarditis möglich. Auch der Integrin-Antagonist als neue Therapie kommt ursächlich in Frage. Das therapeutische Management bei unklarer Beschwerdeursache richtet sich nach den Beschwerden und der wahrscheinlichsten Krankheitsursache. Bei Nichtansprechen der Therapie frühzeitige Re-Evaluationen durchführen.

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Recurrent myocarditis in a patient with active ulcerative colitis: a case report and review of the literature

Cited by 15 publications

References 40 publications

The Masquerading Myocarditis: A Case of Late Recurrence of Acute Myocarditis Presenting as “Peripartum Cardiomyopathy”

The Masquerading Myocarditis: A Case of Late Recurrence of Acute Myocarditis Presenting as “Peripartum Cardiomyopathy”

Analysis of clinical characteristics of mesalazine-induced cardiotoxicity

Perimyokarditis als Komplikation einer medikamentösen Mehrfachtherapie bei Colitis ulcerosa

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