Myopericarditis in a patient with ulcerative colitis treated with mesalamine-Case report and review of the literature

Abstract

Mesalamine has been successfully used as a maintenance treatment in inflammatory bowel diseases such as ulcerative colitis and Crohn's disease for years. Most frequent adverse reactions to this medication are gastrointestinal disorders and headaches while cardiovascular complications are rare and poorly understood. We present a case of a 26-year-old male with ulcerative colitis developing myopericarditis on mesalamine therapy. Although cardiac involvement is reported to be an extraintestinal manifestation of the bowel disease, we describe evidence confirming the diagnosis of mesalamine-induced myopericarditis in our patient and discuss other reports on this topic. Even though myopericarditis is an uncommon adverse reaction to mesalamine, it should be considered in patients with chest pain during mesalamine therapy. In such cases, drug withdrawal may result in rapid clinical improvement. <Learning objective: Mesalamine therapy of inflammatory bowel disease (IBD) can be connected with common adverse reactions such as headaches and gastrointestinal problems. Cardiovascular complications in patients with IBD may be associated with the disease but may also occur due to mesalamine therapy. Drug cessation is then sufficient to achieve clinical improvement.>.

Keywords: Drug adverse reaction; Mesalamine; Myopericarditis; Ulcerative colitis.

Fig. 1

The electrocardiogram course. (A) Off mesalamine (28.11); (B) On mesalamine (01.12); (C) On mesalamine (03.12); (D) Off mesalamine (08.12).

Fig. 2

Computed tomographic angiography excluded pulmonary embolism.

Fig. 3

Echocardiogram on admission showed no pericardial effusion.