Korean J Gastroenterol.  2024 May;83(5):197-199. 10.4166/kjg.2024.024.

Perimyocarditis in a Patient with Ulcerative Colitis Treated with 5-Aminosalicylic Acid

• Lee HY
• Baek DH

• KMID: 2555972
• DOI: http://doi.org/10.4166/kjg.2024.024

Abstract

5-Aminosalicylic acid (5-ASA) is recommended for managing ulcerative colitis. Common adverse effects associated with 5-ASA include gastrointestinal disorders, headaches, and skin rashes. Perimyocarditis induced by 5-ASA is a rare adverse effect, with only a limited number of cases reported. This paper presents a case of 5-ASA-induced perimyocarditis in a 29-year-old female who had been taking 5-ASA for three weeks. The patient was admitted to the emergency department with dyspnea, chest discomfort, and fever. She subsequently underwent laboratory investigations, including electrocardiography, transthoracic echocardiography, chest computed tomographic angiography, cardiac magnetic resonance imaging, and heart biopsy. Intravenous steroid was administered, and 5-ASA was discontinued. The patient’s signs and symptoms improved significantly within a few days of discontinuing 5-ASA, leading to her subsequent discharge. This case highlights the importance of considering perimyocarditis in patients exhibiting cardiac symptoms during 5-ASA therapy, despite it being a rare adverse effect. Drug withdrawal in such cases may lead to rapid clinical improvement.

Keyword

Perimyocarditis; 5-Aminosalicylic acid; Ulcerative colitis

Figure

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  Fig. 1 Cardiac magnetic resonance imaging showed diffuse pericardial late gadolinium enhancement (LGE) in the lateral wall of the left ventricle (arrow) and pericardial effusion (arrow). (A) Axial LGE. (B) Sagittal LGE.

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  Fig. 2 Histological examination of heart biopsy specimens revealed mixed inflammatory cell infiltrate comprising lymphocytes, histiocytes, and eosinophils, which is consistent with perimyocarditis. (A) H&E, ×40. (B) H&E, ×200.

Reference

1. Sehgal P, Colombel JF, Aboubakr A, Narula N. 2018; Systematic review: safety of mesalazine in ulcerative colitis. Aliment Pharmacol Ther. 47:1597–1609. DOI: 10.1111/apt.14688. PMID: 29722441.

2. Brown G. 2016; 5-Aminosalicylic acid-associated myocarditis and pericarditis: A narrative review. Can J Hosp Pharm. 69:466–472. DOI: 10.4212/cjhp.v69i6.1610. PMID: 28123193. PMCID: PMC5242279.

3. Kim H, Jeon H, Kong H, et al. 2006; A molecular mechanism for the anti-inflammatory effect of taurine-conjugated 5-aminosalicylic acid in inflamed colon. Mol Pharmacol. 69:1405–1412. DOI: 10.1124/mol.105.020578. PMID: 16407467.

4. Kaiser GC, Milov DE, Erhart NA, Bailey DJ. 1997; Massive pericardial effusion in a child following the administration of mesalamine. J Pediatr Gastroenterol Nutr. 25:435–438. DOI: 10.1002/j.1536-4801.1997.tb01785.x. PMID: 9327378.

5. Park EH, Kim BJ, Huh JK, et al. 2012; Recurrent mesalazine-induced myopericarditis in a patient with ulcerative colitis. J Cardiovasc Ultrasound. 20:154–156. DOI: 10.4250/jcu.2012.20.3.154. PMID: 23185660. PMCID: PMC3498314.

6. Tschöpe C, Cooper LT, Torre-Amione G, Van Linthout S. 2019; Management of myocarditis-related cardiomyopathy in adults. Circ Res. 124:1568–1583. DOI: 10.1161/CIRCRESAHA.118.313578. PMID: 31120823.

7. Triantafillidis JK, Cheracakis P, Mylonaki M, et al. 2009; Myocarditis due to mesalamine treatment in a patient with ulcerative colitis: favorable outcome after infliximab treatment. Ann Gastroenterol. 22:62–64.

8. Ammirati E, Frigerio M, Adler ED, et al. 2020; Management of acute myocarditis and chronic inflammatory cardiomyopathy: An expert consensus document. Circ Heart Fail. 13:e007405. DOI: 10.1161/CIRCHEARTFAILURE.120.007405. PMID: 33176455. PMCID: PMC7673642.