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Case Reports
. 2023 Jul;14(7):237-243.
doi: 10.14740/jmc4104. Epub 2023 Jul 31.

Myocarditis Related to the Use of Mesalazine

Michaela Kyriakou  1 , Stefanos Sakellaropoulos  2 , Thrasos Constantinides  3 , Grigorios Chatzantonis  4   5 , Panayiotis Avraamides  1 , Andreas Mitsis  1
Affiliations
Case Reports

Myocarditis Related to the Use of Mesalazine

Michaela Kyriakou et al. J Med Cases. 2023 Jul.

Abstract

Myocarditis is a rare complication of therapy with mesalazine, a drug traditionally used in the treatment of inflammatory bowel disease. We report a case of a 32-year-old man with a recent diagnosis of ulcerative colitis, who presented to our hospital with chest pain and elevated troponin, 12 days following initiation of mesalazine. Diagnosis of myocarditis was confirmed with cardiac magnetic resonance imaging (CMR), which showed subepicardial gadolinium enhancement in the basal lateral/inferolateral segment of the heart. The patient's clinical condition improved upon stopping mesalazine and the follow-up CMR demonstrated resolution of the previous findings. Mesalazine can cause myocarditis early after initiation and clinicians should be aware of this rare yet serious cardiotoxic effect, as the discontinuation of the medication is the mainstay of treatment and leads to significant recovery.

Keywords: Cardiac magnetic resonance; Inflammatory bowel disease; Mesalazine; Myocarditis; Ulcerative colitis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Resting 12-lead electrocardiogram demonstrating sinus rhythm with concave ST-segment elevation in I, II, V4-6.
Figure 2
Figure 2
Coronary angiogram revealing normal coronaries, free of significant disease. (a) LAO view of RCA. (b) LAO cranial view of LCA. LAO: left anterior oblique; RCA: right coronary artery; LCA: left coronary artery.
Figure 3
Figure 3
T2-weighted images and LGE distribution during initial study. High intensity signal (white stars) of the basal lateral and apical septum wall segments on T2-weighted images (a, b) indicating myocardial edema, with associated LGE of the same areas (c, d), findings indicative of acute myocarditis. LGE: late gadolinium enhancement.
Figure 4
Figure 4
LGE images, during the initial presentation and in follow-up study. LGE images show subepicardial LGE of the basal lateral and apical septum wall segments (white stars), as well as patchy LGE distribution in a nonischemic pattern with significant improvement on follow-up. LGE: late gadolinium enhancement.
See this image and copyright information in PMC

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