Mesalamine-induced myopericarditis in a paediatric patient with Crohn’s disease

Abstract

Mesalamine-containing products are considered first-line treatment for inflammatory bowel disease. Myocarditis is recognised as a very rare possible side effect of these medications, but has not often been described in the paediatric population. We present a case of an adolescent with Crohn's disease who presented with myopericarditis after recent initiation of Pentasa. Once identified as the causative agent, the drug was discontinued, with subsequent normalisation of troponin and improvement of function. This case identifies the importance of prompt evaluation, diagnosis, and treatment of paediatric patients receiving mesalamine-containing medications that present with significant cardiovascular symptoms.

5-Aminosalicylic Acid–Associated Myocarditis and Pericarditis: A Narrative Review

“…23 Electrocardiography may show evidence of myocarditis; ST wave depression has been reported, 3 but ST wave elevation is more common. 8,13,15,23,26,32,33,35,36,44,48,50,51 Nonspecific findings of flipped T waves were also evident in some cases. 7,11,17,29,30,43,46,49 Cardiac echocardiography commonly showed the presence of pericardial effusion.…”

“…The patients described in these reports frequently, but not inevitably, presented with fever (Table 1), chest pain, 3,[6][7][8]11,[13][14][15][16][17]19,23,24,27,30,31,[36][37][38]40,[44][45][46][48][49][50]52,53 and shortness of breath. 7,16,17,24,29,30,32,36,46,52 The symptom of lassitude or fatigue was also common at the time of presentation.…”

“…For permission to reprint multiple copies or to order presentation-ready copies for distribution, contact CJHP at cjhpedit@cshp.ca Table 1 was sometimes noted. 5,6 The extent of the myocarditis was sometimes indicated by depressed contractility 8,13,27,31,32,40,43,44,48,50 shown by echocardiography. There is no pathognomonic laboratory test that can prove the presence of 5-ASA toxicity.…”

“…Eosinophilia has sometimes been noted in the leukocyte differential analysis. 6,25,33,37,42,44,53 Evidence of inflammation was frequently indicated by elevation of the erythrocyte sedimentation rate (Table 1) [13][14][15]27,30,32,36,38,40,43,46,[48][49][50][51] Elevated N-terminal pro-brain natriuretic peptide concentrations have also been found. 42,44 The presence or absence of any or all of the above symptoms and signs does not confirm the role of 5-ASA in the origin of the condition.…”

Pericarditis during infliximab therapy in paediatric ulcerative colitis

“…Pericarditis is a very rare, but clinically significant, adverse event related to drugs used to treat inflammatory bowel diseases (IBDs), such as mesalazine, sulfasalazine and azathioprine . Pericarditis has also been recognized as a very rare adverse event that can be associated with the use of infliximab in patients with IBD .…”