J Cardiovasc Ultrasound.  2016 Jun;24(2):163-167. 10.4250/jcu.2016.24.2.163.

Successfully Treated Acute Fulminant Myocarditis Induced by Ulcerative Colitis with Extracorporeal Life Support and Infliximab

• Kim HK
• Kim KI
• Jung SW
• Mun HS
• Cho JR
• Lee N
• Kang MK

• KMID: 2308707
• DOI: http://doi.org/10.4250/jcu.2016.24.2.163

Abstract

We report a case of successfully treated acute fulminant myocarditis induced by ulcerative colitis with extracorporeal life support and infliximab. Myocarditis is a rare but crucial complication during an exacerbation of inflammatory bowel disease. In our case, we applied extracorporeal membrane oxygenation (ECMO) for cardiac rest under impression of acute myocarditis associated with ulcerative colitis, and added infliximab for uncontrolled inflammation by corticosteroid. As a result, our patient was completely recovered with successful weaning of ECMO.

Keyword

Myocarditis; Ulcerative colitis; Extracorporeal membrane oxygenation

MeSH Terms

Colitis, Ulcerative*
Extracorporeal Membrane Oxygenation
Humans
Inflammation
Inflammatory Bowel Diseases
Infliximab*
Myocarditis*
Ulcer*
Weaning
Infliximab

Figure

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  Fig. 1 Initial echocardiography shows dilated left ventricle by 2D (A) and decreased left ventricular (LV) ejection fraction about 33% by M-mode (B). Velocity time integral from LV out flow track showed 12 cm (C) but relatively preserved LV myocardial tissue velocities (D).

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  Fig. 2 Coronary aniography shows normal left (A) and right (B) coronary arteries.

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  Fig. 3 Follow up echocardiography after extracorporeal life support shows further decreased left ventricular ejection fraction and velocity time integral (A, B, and C) and depressed myocardial tissue velocities (D).

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  Fig. 4 Increased left ventricular wall thickness was detected after ECMO procedure (A and B) and still depressed velocity time integral from left ventricular out flow track and myocardial tissue velocities (C and D). ECMO: extracorporeal membrane oxygenation.

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  Fig. 5 The echocardiography after infusion of infliximab showed still increased left ventricular (LV) wall thickness but improved LV systolic function (A and B) and velocity time integral from LV out flow track and myocardial tissue velocities (C and D).

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  Fig. 6 The last echocardiographic study showed completely recovered myocardial function and resolved myocardial thickness. Normalized left ventricular (LV) wall thickness and improved LV systolic funciton (A and B) and normalized velocity time integral from LV out flow track and myocardial tissue velocities (C and D).

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  Fig. 7 Improvement of initial sinus tachycardia with non-specific ST changes on ECG (A) to normal sinus rhythm (B) and initial cardiomegaly and pulmonary congestion on chest X-ray (C) to normal (D). ECG: electrocardiography.

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