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Journal of Medical Case Reports

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Open Access 01-12-2018 | Case report

Mesalazine-induced myocarditis: a case report

Authors: Shiva T. Radhakrishnan, Aruchuna Mohanaruban, Sami Hoque

Published in: Journal of Medical Case Reports | Issue 1/2018

Abstract

Background

Myocarditis is a rare complication of therapy with mesalazine, a drug widely prescribed in the treatment of inflammatory bowel disease.

Case presentation

We report a case of myocarditis occurring in a 49-year-old British man 10 days following initiation of mesalazine therapy for treatment of ulcerative colitis. He presented with troponin-positive chest pain, and the diagnosis of myocarditis was confirmed on the basis of cardiac magnetic resonance imaging, which showed subepicardial delayed gadolinium enhancement in the basal to middle inferior and inferolateral segments of the heart. The patient’s symptoms and condition improved upon stopping mesalazine, and he made a full recovery.

Conclusions

Mesalazine-induced myocarditis may be more common than first appreciated and is potentially fatal. Therefore, it is imperative that clinicians be aware of this potentially life-threatening adverse effect of mesalazine therapy and warn patients to seek urgent medical attention if cardiac symptoms arise.

Bergman R, Parkes M. Systematic review: the use of mesalazine in inflammatory bowel disease. Aliment Pharmacol Ther. 2006;23(7):841–55.CrossRefPubMed

Stelts S, Taylor MH, Nappi J, Van Bakel AB. Mesalamine-associated hypersensitivity myocarditis in ulcerative colitis. Ann Pharmacother. 2008;42:904–5.CrossRefPubMed

Loftus Jr EV, Kane SV, Bjorkman DJ. Systematic review: short-term adverse effects of 5-aminosalicyclic acid agents in the treatment of ulcerative colitis. Aliment Pharmacol Ther. 2004;19:179–89.CrossRefPubMed

Ham M, Moss AC. Mesalamine in the treatment and maintenance of remission of ulcerative colitis. Expert Rev Clin Pharmacol. 2012;5(2):113–23.CrossRefPubMedPubMedCentral

Fujiwara M, Mitsui K, Yamamoto I. Inhibition of proliferative responses and interleukin 2 productions by salazosulfapyridine and its metabolites. Jpn J Pharmacol. 1990;54:121–31.CrossRefPubMed

Freeman HJ, Salh B. Recurrent myopericarditis with extensive ulcerative colitis. Can J Cardiol. 2010;26:549–50.CrossRefPubMedPubMedCentral

Rellecke P, Strauer BE. Chronic Inflammatory bowel disease and cardiovascular complications [in German]. Med Klin (Munich). 2006;101 Suppl 1:56–60.

Moss AC, Peppercorn MA. The risks and the benefits of mesalazine as a treatment for ulcerative colitis. Expert Opin Drug Saf. 2007;6:99–107.CrossRefPubMed

Cooper Jr LT. Myocarditis. N Engl J Med. 2009;360:1526–38.CrossRefPubMed

10.

Liu Y, Ye J, Zhu J, Chen W, Sun Y. Myocarditis due to mesalamine treatment in a patient with Crohn’s disease in China. Turk J Gastroenterol. 2012;23(3):304–6.CrossRefPubMed

11.

Doganay L, Akinci B, Pekel N, Simsek I, Akpinar H. Mesalazine-induced myopericarditis in a patient with ulcerative colitis. Int J Colorectal Dis. 2006;21(2):199–200.CrossRefPubMed

12.

Brown G. 5-Aminosalicylic acid-associated myocarditis and pericarditis: a narrative review. Can J Hosp Pharm. 2016;69(6):466–72.PubMedPubMedCentral

13.

Biesbroek PS, Hirsch A, Zweerink A, et al. Additional diagnostic value of CMR to the European Society of Cardiology (ESC) position statement criteria in a large clinical population of patients with suspected myocarditis. Eur Heart J Cardiovasc Imaging. 2017. doi:https://doi.org/10.1093/ehjci/jex308. [Epub ahead of print].

14.

Dominguez F, Kuhl U, Pieske B, Garcia-Parvia P, Tschope C. Update on myocarditis and inflammatory cardiomyopathy: reemergence of endomyocardial biopsy. Rev Esp Cardiol. 2016;69(2):178–87.CrossRefPubMed

Title: Mesalazine-induced myocarditis: a case report
Authors: Shiva T. Radhakrishnan
Aruchuna Mohanaruban
Sami Hoque
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: Journal of Medical Case Reports / Issue 1/2018
Electronic ISSN: 1752-1947
DOI: https://doi.org/10.1186/s13256-017-1557-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Mesalazine-induced myocarditis: a case report

Abstract

Background

Case presentation

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Case presentation

Conclusions

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