Mesalazine-induced myocarditis: a case report

Radhakrishnan, Shiva T.; Mohanaruban, Aruchuna; Hoque, Sami

doi:10.1186/s13256-017-1557-z

Cited by 11 publications

(8 citation statements)

References 14 publications

(13 reference statements)

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“…The onset time of cardiotoxicity for most patients was 2–4 weeks after taking mesalazine, suggesting that we need to pay attention to patients who develop fever, chest pain, and breathing difficulties, especially in the early stages ( Radhakrishnan et al, 2018 ; Shergill, 2021 ). However, in some patients, the onset of cardiotoxicity was delayed for several months to several years ( Okoro et al, 2018 ; Caio et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

Analysis of clinical characteristics of mesalazine-induced cardiotoxicity

et al. 2022

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Background: Mesalazine is the first-line inflammatory bowel disease (IBD) treatment. However, it can cause fatal cardiotoxicity. We aimed to analyze the clinical characteristics of mesalazine-induced cardiotoxicity and provide evidence for clinical diagnosis, treatment, and prevention.Methods: We collected Chinese and English literature on mesalazine-induced cardiotoxicity from 1970 to 2021 for retrospective analysis.Results: A total of 52 patients (40 males and 12 females) were included, with a median age of 24.5 years (range 9–62) and a median onset time of 14 days (range 2–2880). Cardiotoxicity manifested as myocarditis, pericarditis, and cardiac pericarditis. The main clinical manifestations are chest pain (82.7%), fever (46.2%), and respiratory symptoms such as dyspnea and cough (40.4%). The levels of troponin T, creatine kinase, C-reactive protein, leukocyte count, erythrocyte sedimentation rate, and other biochemical markers were significantly increased. Cardiac imaging often suggests myocardial infarction, pericardial effusion, myocardial necrosis, and other symptoms of cardiac injury. It is essential to discontinue mesalamine immediately in patients with cardiotoxicity. Although corticosteroids are a standard treatment option, the benefits remain to be determined. Re-challenge of mesalamine should be carefully considered as cardiotoxic symptoms may reoccur.Conclusion: Mesalazine may cause cardiotoxicity in patients with inflammatory bowel disease, which should be comprehensively diagnosed based on clinical manifestations, biochemical indicators, and cardiac function imaging examinations. Mesalazine should be immediately discontinued, and corticosteroids may be an effective treatment for cardiotoxicity.

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Section: Discussionmentioning

confidence: 99%

Analysis of clinical characteristics of mesalazine-induced cardiotoxicity

et al. 2022

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“…12 MSZ induced myocarditis usually appears within 4 weeks from the beginning of the treatment, but concomitant corticosteroid use could delay the onset of the cardiotoxicity. MSZ-induced myocarditis has been reported in literature both in the treatment of UC, [8][9][10][11][12][13][14][15][16] Crohn's disease [17][18][19] and in newly diagnosed IBD. 21 Up to now, more than 51 cases of MSZ induced myocarditis have been reported.…”

Section: Discussionmentioning

confidence: 99%

“…2 Despite rare, cardiac extraintestinal manifestations, such as pericarditis and myocarditis, are more commonly reported to occur in UC than Crohn's disease patients. 7 In addition, in patients with IBD myocarditis could be triggered by drugs currently used to treat this condition [8][9][10][11][12][13][14][15][16][17][18][19] such as mesalazine (MSZ) or biological agents, 20 and in newly diagnosed IBD. 21 Last but not least, Coxackie viruses, Parvovirus B19, Adenoviruses and enteroviruses can be aetiological agents for myocarditis.…”

Section: Introductionmentioning

confidence: 99%

Recurrent myocarditis in a patient with active ulcerative colitis: a case report and review of the literature

Caio

Lungaro

Caputo

et al. 2021

BMJ Open Gastroenterol

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Inflammatory bowel diseases such as ulcerative colitis (UC) may be complicated by several extraintestinal manifestations. These involve joints, skin, eyes and less commonly lungs and heart. Myocarditis may result from the toxic effect of drugs (ie, mesalazine) commonly used for the treatment of UC or due to infections (eg, Coxsackieviruses, enteroviruses, adenovirus). Here, we report a case of a 26-year old man affected by UC and complicated by two episodes of myocarditis. Both episodes occurred during two severe exacerbations of UC. However, in both cases the aetiology of myocarditis remains uncertain being ascribable to extraintestinal manifestation, drug toxicity or both.

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“…The use of CMR to confirm the diagnosis of mesalamine-induced cardiotoxicity has been seldom reported [2,5]. Given the potential serious outcomes associated with undiagnosed mesalamine-induced cardiotoxicity, it is essential to acknowledge the presence of such an entity and emphasize that CMR is the diagnostic test of choice.…”

Section: Discussionmentioning

confidence: 99%

Mesalamine-induced Myocarditis in a Young Athlete: Can He Run Again?

Ibrahim

Khalil

Megaly

et al. 2019

Cureus

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Mesalamine is often used in the treatment of inflammatory bowel disease (IBD). Mesalamine-induced cardiotoxicity has been reported in the literature and is a rare entity. The mechanism of cardiotoxicity remains unclear, however, it is believed to be due to a humoral-mediated hypersensitivity reaction. Patients with mesalamine-induced cardiotoxicity could present with a wide range of cardiovascular symptoms ranging from mild chest pain and shortness of breath (SOB) to cardiogenic shock secondary to left ventricular systolic dysfunction. Symptoms could be associated with elevation in cardiac biomarkers and electrocardiogram (EKG) changes including ST-segment or T-wave abnormalities. We report a case of mesalamine-induced myocarditis in a young athlete presenting with chest pain 10 days after mesalamine therapy was initiated for recently diagnosed Crohn’s disease. Workup was significant for elevated cardiac biomarkers. The diagnosis was confirmed with cardiovascular magnetic resonance imaging (CMR). Immediate cessation of the medication resulted in resolution of symptomatology and normalization of cardiac biomarkers over a 48-hour period. Mesalamine-induced cardiotoxicity is a rare, yet serious side effect that necessitates medical community awareness. CMR is the confirmatory diagnostic modality of choice.

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Mesalazine-induced myocarditis: a case report

Cited by 11 publications

References 14 publications

Analysis of clinical characteristics of mesalazine-induced cardiotoxicity

Analysis of clinical characteristics of mesalazine-induced cardiotoxicity

Recurrent myocarditis in a patient with active ulcerative colitis: a case report and review of the literature

Mesalamine-induced Myocarditis in a Young Athlete: Can He Run Again?

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