Korean J Gastroenterol.  2022 Jan;79(1):31-34. 10.4166/kjg.2021.152.

5-Aminosalicylic Acid-induced Myocarditis in a Patient with Atypical Ulcerative Colitis

• Song HY
• Seo GS

• KMID: 2525520
• DOI: http://doi.org/10.4166/kjg.2021.152

Abstract

5-aminosalicylic acid (5-ASA) is used widely to treat ulcerative colitis. The common side effects of 5-ASA include nausea, vomiting, abdominal pain, headache, and skin rash. 5-ASA-induced myocarditis is a rare side effect, and few cases have been reported. 5-ASA-induced myocarditis usually occurs within 2-4 weeks of drug use and causes chest pain and dyspnea. This paper reports 5-ASA-induced myocarditis in a 31-year-old male patient who took 5-ASA for 20 days prior. The patient was hospitalized with dyspnea that worsened when lying down, with chest pain radiating to the left neck, fever, and vomiting. Myocarditis was suspected. The work-up included electrocardiogram, transthoracic echocardiogram, cardiac MRI, and laboratory investigations. The patient’s signs and symptoms improved within a few days after withdrawing 5-ASA. This case shows that an evaluation including the possibility of myocarditis should be performed when patients with ulcerative colitis receiving 5-ASA present with cardiac problems, such as dyspnea and chest pain.

Keyword

Colitis; ulcerative; 5-aminosalicylic acid; Myocarditis

Figure

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  Fig. 1 Chest radiography and chest computed tomography (CT) images. (A) Chest radiograph demonstrated homogenously increased pulmonary parenchymal opacification in both lung fields. (B) Chest CT demonstrated peripheral ground-glass opacities and thickening of bronchovascular bundles.

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  Fig. 2 Cardiac magnetic resonance imaging (MRI) images. Cardiac MRI showed midwall and subepicardial delayed gadolinium enhancement in the (A, B) septal (arrows), (C) lateral (arrow), and (D) inferolateral segment (arrow) at the basal level and in the septal segment at the mid-ventricular level.

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  Fig. 3 Endoscopic findings. (A) Erosion with a normal vascular pattern in the ascending colon. (B, C) Obliteration of the vascular pattern, mucosal friability, and multiple deep ulcerations in the sigmoid colon. (D) Normal vascular pattern and no visible erosion or ulcer in the rectum.

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