Shibu Roney, Mohsen Waled
Royal Brisbane & Women's Hospital, Brisbane, Australia.
Department of Digestive Diseases, Gold Coast University Hospital, Gold Coast, Australia.
ACG Case Rep J. 2024 Jun 3;11(6):e01371. doi: 10.14309/crj.0000000000001371. eCollection 2024 Jun.
Cardiac extraintestinal manifestations (EIMs) of Crohn's disease (CD) are uncommon. They include pericarditis, myocarditis, and arrhythmias; however, distinguishing these from alternative causes including medication-related adverse effects is often challenging. Leukocytoclastic vasculitis is another uncommon EIM of CD that may present with systemic involvement. We present a rare case of myocarditis associated with leukocytoclastic vasculitis occurring as EIMs of CD. The myocarditis proved refractory to standard therapy and biologics targeting underlying gut inflammation. She developed an inflammatory cardiomyopathy and symptoms consistent with heart failure with preserved ejection fraction. Anakinra was tried, but despite the initial response, it should be used cautiously in patients with CD.
克罗恩病（CD）的心脏肠外表现（EIMs）并不常见。这些表现包括心包炎、心肌炎和心律失常；然而，将这些表现与包括药物相关不良反应在内的其他病因区分开来往往具有挑战性。白细胞破碎性血管炎是CD另一种不常见的EIM，可能伴有全身受累。我们报告一例罕见的心肌炎合并白细胞破碎性血管炎，作为CD的EIM出现。该心肌炎对标准治疗和针对潜在肠道炎症的生物制剂均无效。她发展为炎症性心肌病，出现与射血分数保留的心力衰竭一致的症状。尝试使用了阿那白滞素，但尽管有初始反应，但在CD患者中应谨慎使用。
