Recurrent lymphocytic myocarditis in a young male with ulcerative colitis

Abstract

Awareness of myocarditis in association with inflammatory bowel diseases is crucial as it bears a rare but serious risk for mortality. This report describes the case of a young Caucasian male, whose heart biopsy was tested negative for giant cells and bacterial or viral genomes or proteins. He was experiencing severe lymphocytic myocarditis (other than mesalamine-induced) along with cardiogenic shock during ulcerative colitis exacerbation. This is an extremely rare, if not unique, clinical constellation. We chose to study the epidemiologic grounds and all major aspects of differential pathogenesis and treatment of this serious health problem.

Figure 1

Transthoracic cardiac echocardiogramms. At ICU admission: (A) long axis view, and (B) short axis view; both views show a pericardial effusion of 1.6 cm. At ICU discharge: (C) long axis view, and (D) short axis view; both views confirm significant reduction of pericardial effusion.

Figure 2

Histology images revealed acute myocarditis with lymphocytic infiltration and moderate myocyte apoptosis at first onset (A) and relapse (B). These biopsies did not detect giant cells or significant neutrophile infiltrates.

Figure 3

Transthoracic cardiac echocardiogramms. (A) Long axis view. (B) Short axis view. These views show a pericardial effusion of 0.8 cm at readmission.

Figure 4

Cardiac magnetic resonance imaging (MRI), turbo inversion recovery magnitude (TIRM) sequence. (A) Edema in anterior wall. (B) Pericardial effusion of 1.2 cm.

Figure 5

Cardiac magnetic resonance imaging (MRI), balanced steady-state free precesion (bSSFP) sequence. (A-C) These images show pericardial effusion of 1.2 cm.

Figure 6

Cardiac magnetic resonance imaging (MRI), inversion recovery (IR) turbo fast low-angle shot (FLASH) sequence. (A) Beginning enhancement in lateral wall. (B-C) Intramural late-enhancement in lateral wall.

Figure 7

Medication curves. The graph illustrates dose and application time of systemic treatment with prednisone, azathioprine and mesalamine and local therapy with budesonide during the entire observation period. This graph also indicates the time points of clinical exacerbation of ulcerative colitis along with emergence of myocarditis symptoms.