Mesalazine-induced Pleuropericarditis in a Patient with Crohn's Disease

Abstract

A 16-year-old boy was diagnosed with Crohn's disease. Treatment with oral mesalazine was started at 3 g per day; however, he complained of high fever, a nonproductive cough, and left shoulder pain after 2 weeks. His chest radiography and chest computed tomography showed cardiomegaly and left pleural effusion, while an echocardiogram revealed pericardial effusion. Because no infection was detected by thoracentesis and the drug lymphocyte stimulation tests for mesalazine were positive, the patient was diagnosed with mesalazineinduced pleuropericarditis. After the cessation of mesalazine, the clinical symptoms and laboratory findings quickly improved.

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 .…”

“…Proinflammatory activity in certain tissues, including the pericardium, was hypothesized . Direct cardiac toxicity, immunoglobulin E‐mediated allergic reaction, humoral antibody response and cell‐mediated hypersensitivity delayed reaction, causing a serum sickness‐like reaction (in which pericarditis would be a component), have also been suggested as possible mechanisms. Despite these findings, further research is warranted.…”

Eosinophilia and Ulcerative Colitis Associated with Eosinophilic Myocarditis

“…For example, although 5-aminosalicylic acid can be used to treat ulcerative colitis, it can also cause eosinophilia, pericarditis, and myocarditis. [20][21][22][23][24] Of note, our patient had never taken this medication because his ulcerative colitis was newly diagnosed.…”

Comprehensive review of cardiovascular toxicity of drugs and related agents

“…The connection is usually based on case reports. Currently, it seems that hypersensitive reactions, in particular development of lupus erythematosus, and excessive anticoagulant treatment leading to intrapericardial bleeding are among the most common causes of drug‐developed pericarditis . Several anticancer drugs have a less clear etiology, but hypersensitivity can play a role .…”

“…Currently, it seems that hypersensitive reactions, in particular development of lupus erythematosus, and excessive anticoagulant treatment leading to intrapericardial bleeding are among the most common causes of drug-developed pericarditis. [373][374][375][376][377][378][379][380][381][382][383] Several anticancer drugs have a less clear etiology, but hypersensitivity can play a role. [384][385][386] Similarly, pericardial effusion caused by specific bcr-abl tyrosine kinase inhibitors can have an immune background.…”