Comment: Mesalamine-Associated Hypersensitivity Myocarditis in Ulcerative Colitis and the Kounis Syndrome

Kounis, George N.; Kouni, Sophia A.; Chiladakis, John; Kounis, Nicholas G.

doi:10.1345/aph.1k288a

Cited by 8 publications

(5 citation statements)

References 4 publications

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“…Yet, the exact mechanism by which mesalamine might prompt myocardial inflammation is not clearly identified. Rarely, mesalamine can induce hypersensitive reactions such as, hypersensitivity pneumonitis, angioedema, skin rashes, hypereosinophilia and thus, a mechanism of hypersensitivity to the drug rather than a direct cytotoxic effect is suspected [1–6]. The diagnosis of hypersensitivity myocarditis (HSM) is also suggested by the fact that, in all of the cases identified as being the result of mesalamine toxicity [1–3], there had been a clear improvement following the discontinuation of the drug.…”

Section: Discussionmentioning

confidence: 99%

“…Different mechanisms could explain HSM but the exact one has not yet been identified. The most probable hypothesis seems to be an inhibition of cyclooxygenase-1 (COX1) by the drug, which may accelerate the metabolism of arachidonic acid toward lipoxygenase products such as, leukotrienes [6]. This overproduction of leukotriene metabolites may induce proinflammatory signaling, initiating the hypersensitive reaction by liberating eosinophil-stimulating cytokines, and will lead to the myocarditis.…”

Section: Discussionmentioning

confidence: 99%

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Mesalamine-Induced Myocarditis

Merceron

Bailly

Khalil

et al. 2010

Cardiology Research and Practice

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Mesalamine-Induced Myocarditis

Merceron

Bailly

Khalil

et al. 2010

Cardiology Research and Practice

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“…Hypersensitivity reaction is probably a result of accelerated metabolism of arachidonic acid to leukotrienes due to cyclooxygenase-1 enzyme inhibition. Leukotrienes in turn result in overproduction of eosinophil stimulating cytokines which cause a hypersensitivity reaction resulting in myocarditis [16,17]. Hypersensitivity due to humoral-mediated response has also been suggested resulting in the formation of antibodies against mesalazine, with cross-reactivity to myocardium or pericardium [18].…”

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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“…Kounis et al explained the possible mechanism of the inhibition of cyclooxigenase-1 enzyme (COX-1) and, thus, overproduction of leucotriens which further promote an initiation of hypersensitivity reaction via eosinophil secreting factor induced by proinflammatory signals and, eventually, causing myocarditis. The relationship between mesalazine and myocarditis is thought to be due to hypersensitivity reaction rather than cytotoxic effects (2,3). Previous studies showed eosinophilic infiltration of the myocard in mesalazine associated myocarditis in biopsy (4).…”

Section: öZetmentioning

confidence: 99%

“…Mesalazine associated eosinophilic myocarditis or giant cell myocarditis was considered in our case. Because a provocative test with etiologic agent could lead fatal damage, it was not performed (2)(3)(4). Similarly, we did not perfom an endomyocardial biopsy because the patient refused to consent to the biopsy.…”

Section: öZetmentioning

confidence: 99%

Myocarditis Associated with Mesalazine: A Case Report

2015

J Turgut Ozal Med Cent

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Acute myocarditis is a life-threatening inflammatory disease of the heart muscle. It usually occurs after a viral infection and it is often asymptomatic. Mesalazine is commonly used for the treatment of inflammatory bowel disease. Mesalazine rarely causes acute myocarditis, but the exact mechanism is unclear. A 32-year-old female patient using mesalazine with a diagnosis inflammatory bowel disease was admitted to the emergency department with shortness of breath. The patient showed signs of acute decompansated heart failure. Bedside echocardiography examination showed a reduced left ventricular systolic function. The patient was followed with a diagnosis of fulminant myocarditis and mechanical ventilation and inotropic support was started. The patient has dramatically improved after stopping treatment of mesalazine. Myocarditis due to any drug use should be taken into consideration in patients receiving mesalazine therapy.

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Comment: Mesalamine-Associated Hypersensitivity Myocarditis in Ulcerative Colitis and the Kounis Syndrome

Abstract: exclude contemporarycoronary mast cell activationmanifestingas KS. However,this report shows that HSM and KS are very rarelydiagnosed diseasesratherthan very rare diseases.

Cited by 8 publications

References 4 publications

Mesalamine-Induced Myocarditis

Mesalamine-Induced Myocarditis

Mesalazine-Induced Cardiotoxicity

Myocarditis Associated with Mesalazine: A Case Report

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