Giant Cell Myocarditis in a Patient With Crohn's Disease, Treated with Etanercept – A Tumour Necrosis Factor-Alpha Antagonist

Abstract

Cardiac disease in association with inflammatory bowel disease (IBD) is uncommon. Reports include pericarditis, pericardial effusion, myocarditis, myocardial infarction, endocarditis and arrythmias. Myocardial inflammation related to IBD may be due to a drug hypersensitivity reaction or micronutrient deficiency, or may be secondary to the underlying IBD as an extraintestinal manifestation. In this setting, myocarditis usually presents as congestive heart failure and/or refractory arrhythmia. Prognosis varies among reported cases, including complete recovery, remission with recurrence and fatal disease. Treatment of myocarditis has included aminosalicylates and immunosuppressive medications. Recently, newer therapies for IBD have been developed, such as tumour necrosis factor-alpha (TNF-a) antagonists. The present report describes a case of a 46-year-old man with clinical and endoscopic evidence of moderately active colonic Crohn's disease who developed congestive heart failure due to giant cell myocarditis. Little clinical improvement occurred with immunosuppressive therapy. Only after the addition of etanercept, a TNF-a p75 receptor antagonist, did complete clinical resolution occur. These authors conclude that the use of TNF-a antagonists may be considered in the treatment of life-threatening extraintestinal manifestations of inflammatory bowel disease.

Myocarditis Associated with Mesalazine: A Case Report

“…Although patients with a hypersensitivity disease may develop arteritis, acute myocardial infarction rarely occurs (5). In several studies, development of giant cell myocarditis was shown hystologically in the course of otoimmune disorders such as Crohn's disease (6). Mesalazine associated eosinophilic myocarditis or giant cell myocarditis was considered in our case.…”

Transient Myocarditis Associated with Fulminant Colitis

“…Myocarditis (cardiac muscle inflammation) is associated with symptoms of congestive cardiac failure, chest pain, arrhythmias, syncope, and sudden death [1–3]. Myocarditis can be broadly classified into infective and noninfective causes.…”

“…Inflammatory bowel disease is uncommonly associated with cardiac disease [1–3]. These extraintestinal manifestations include pericarditis, pericardial effusion, myocarditis, myocardial infarction, endocarditis, and arrhythmias [1, 3].…”

“…These extraintestinal manifestations include pericarditis, pericardial effusion, myocarditis, myocardial infarction, endocarditis, and arrhythmias [1, 3]. Although rare, myocardial inflammation related to inflammatory bowel disease is normally associated with the presence of multinucleate giant cells [1–3]. …”

Treatment of the extraintestinal manifestations of inflammatory bowel disease

“…Recently a 46-year-old male patient who had moderately active Crohn's colitis presented with congestive heart failure from biopsy-proven giant cell myocarditis [27]. The patient's bowel disease was resistant to corticosteroids, and his myocarditis developed while he was on prednisone, 15 mg/d.…”