J Cardiovasc Ultrasound.  2012 Sep;20(3):154-156. 10.4250/jcu.2012.20.3.154.

Recurrent Mesalazine-Induced Myopericarditis in a Patient with Ulcerative Colitis

• Park EH
• Kim BJ
• Huh JK
• Jeong EH
• Lee SH
• Bang KB
• Seol JS
• Sung JW
• Kim BS
• Kang JH

• KMID: 1808352
• DOI: http://doi.org/10.4250/jcu.2012.20.3.154

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.

Keyword

Myopericarditis; Mesalazine; Inflammatory bowel disease

MeSH Terms

Adult
Aspirin
Colitis, Ulcerative
Electrocardiography
Fever
Humans
Inflammatory Bowel Diseases
Male
Mesalamine
Pericarditis
Rare Diseases
Sulfasalazine
Thorax
Ulcer
Aspirin
Mesalamine
Sulfasalazine

Figure

• 

  Fig. 1 Electrocardiographic findings on first admission. This ECG was recorded with time scale of 25 mm/s on the horizontal axis and a voltage sensitivity of 10 mm/mV on the vertical axis. A: ST segment elevation on lead I, II, aVL, V2-6 without reciprocal change at first admission. B: Improved ST segment elevation at discharge. ECG: electrocardiogram.

• 

  Fig. 2 Echocardiographic findings on first admission. A: Minimal pericardial effusion (white arrow) and increased posterolateral pericardial thickness about 0.39 cm (black arrow). B: Improvement of pericardial effusion and increased pericardial thickness at discharge.

Reference

1. Bernal-Sprekelsen JC, de las Marinas MD, Salvador A, Landete FJ, Morera FJ. Recurrent pericarditis in a patient with ulcerative proctitis due to mesalazine suppositories. Int J Colorectal Dis. 2010. 25:1143–1144.

2. Ishikawa N, Imamura T, Nakajima K, Yamaga J, Yuchi H, Ootsuka M, Inatsu H, Aoki T, Eto T. Acute pericarditis associated with 5-aminosalicylic acid (5-ASA) treatment for severe active ulcerative colitis. Intern Med. 2001. 40:901–904.

3. García-Morán S, Sáez-Royuela F, Pérez-Alvarez JC, Gento E, Téllez J. Myopericarditis and mitral insufficiency associated with ulcerative colitis treated with mesalazine. Inflamm Bowel Dis. 2006. 12:334–335.

4. Vayre F, Vayre-Oundjian L, Monsuez JJ. Pericarditis associated with longstanding mesalazine administration in a patient. Int J Cardiol. 1999. 68:243–245.

5. Bernstein CN, Wajda A, Blanchard JF. The clustering of other chronic inflammatory diseases in inflammatory bowel disease: a population-based study. Gastroenterology. 2005. 129:827–836.

6. Sentongo TA, Piccoli DA. Recurrent pericarditis due to mesalamine hypersensitivity: a pediatric case report and review of the literature. J Pediatr Gastroenterol Nutr. 1998. 27:344–347.

7. Perrot S, Aslangul E, Szwebel T, Gadhoum H, Romnicianu S, Le Jeunne C. Sulfasalazine-induced pericarditis in a patient with ulcerative colitis without recurrence when switching to mesalazine. Int J Colorectal Dis. 2007. 22:1119–1121.

8. Jenss H, Becker EW, Weber P. Pericardial effusion during treatment with 5-aminosalicylic acid in a patient with Crohn's disease. Am J Gastroenterol. 1990. 85:332–333.

9. Kristensen KS, Høegholm A, Bohr L, Friis S. Fatal myocarditis associated with mesalazine. Lancet. 1990. 335:605.