Mesalamine-Induced Myocarditis and Coronary Vasculitis in a Pediatric Ulcerative Colitis Patient: A Case Report

Abstract

Mesalamine-containing products are often a first-line treatment for ulcerative colitis. Severe adverse reactions to these products, including cardiovascular toxicity, are rarely seen in pediatric patients. We present a case of a 16-year-old boy with ulcerative colitis treated with Asacol, a mesalamine-containing product, who developed sudden onset chest pain after four weeks on therapy. Serial electrocardiograms showed nonspecific ST segment changes, an echocardiogram showed mildly decreased left ventricular systolic function with mild to moderate left ventricular dilation and coronary ectasia, and his troponins were elevated. Following Asacol discontinuation, his chest pain resolved, troponins were trending towards normal, left ventricular systolic function normalized, and coronary ectasia improved within 24 hours suggesting an Asacol-associated severe drug reaction. Mesalamine-induced cardiovascular toxicity, although rare, may represent a life-threatening disorder. Therefore, every patient presenting with acute chest pain should receive a workup to rule out this rare drug-induced disorder.

Mesalazine-Induced Myopericarditis in a Patient with a Recent Diagnosis of Crohn’s Disease: Apropos of a Case

“…In conclusion, we present a case of mesalazine-induced myopericarditis that was successfully improved by immediate cessation of the medication. In our case, the onset and resolution of symptoms within one week after drug discontinuation were similar to those reported in literature [ 3 , 4 , 7 , 8 ]. This case identifies the importance of prompt evaluation, diagnosis, and eliciting a thorough medical history when new medications are started.…”

Mesalamine-induced myocarditis following diagnosis of Crohn's disease: A case report

“…1,2 One proposed mechanism is humoral-mediated hypersensitivity, in which antibodies formed against mesalamine cross-react with cardiac tissue causing inflammation. 6 The diagnosis of hypersensitivity myocarditis is supported by two facts: inflammation worsens if mesalamine is reintroduced during the acute phase, 1 and resolution of symptoms occurs within one week after drug discontinuation, as has been described in all reported cases. 1---4 Eosinophilic infiltration of the myocardium on endomyocardial biopsy has also been described, 7 which seems to confirm the link between mesalamine and hypersensitivity myocarditis.…”

Mesalamine-induced myocarditis following diagnosis of Crohn's disease: A case report

“…6 The diagnosis of hypersensitivity myocarditis is supported by two facts: inflammation worsens if mesalamine is reintroduced during the acute phase, 1 and resolution of symptoms occurs within one week after drug discontinuation, as has been described in all reported cases.…”