Recurrent Mesalazine-Induced Myopericarditis in a Patient with Ulcerative Colitis

Abstract

Inflammatory bowel disease (IBD) is considered as a dysregulated immune mediated disease. Pericarditis in IBD is a very rare disease both as an extra-intestinal manifestation of IBD and an adverse reaction of therapeutic drug for IBD such as mesalazine or sulfasalazine. A 26-year-old IBD male patient who had been taking mesalazine regularly for about 1 month was referred to our hospital because of fever, chest discomfort, and abnormal electrocardiographic findings. The patients was diagnosed as acute myopericarditis, and recovered after cessation of mesalazine using steroid and aspirin. When mesalazine was re-medicated some days after discharge, he suffered from myopericarditis again. Subsequently, myopericarditis was resolved just after cessation of mesalazine again. These findings suggest that the development of myopericarditis is caused by mesalazine.

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.…”

“…7,11,17,29,30,43,46,49 Cardiac echocardiography commonly showed the presence of pericardial effusion. [4][5][6][7]12,[15][16][17]20,23,24,26,27,29,37,42,44,52 If the pericardial effusion was sufficiently large, cardiac tamponade Table 1 This single copy is for your personal, non-commercial use only. 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.…”

“…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.…”

“…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. The nonspecific findings may also be suggestive of other disease processes, such as ischemic myocardium or other inflammatory conditions of the heart or pericardium.…”