Littlewood Simon, Nikolou Evgenia, Aziz Waqar, Anderson Lisa
School of Biomedical Engineering and Image Science, King's College London, 3rd Floor Lambeth Wing, St Thomas' Hospital, London SE1 7EH, United Kingdom.
Department of Cardiology, St George's Hospital, Blackshaw Road, London SW17 0QT, United Kingdom.
Eur Heart J Case Rep. 2024 Aug 27;8(9):ytae458. doi: 10.1093/ehjcr/ytae458. eCollection 2024 Sep.
Mesalazine is an established first-line therapy for inflammatory bowel disease (IBD) and remains the mainstay of treatment for mild to moderate ulcerative colitis (UC). Both mesalazine and UC are rare but recognized causes of myopericarditis. Cardiac magnetic resonance (CMR) is a non-invasive method of assessing for myopericarditis. This case reports highlights the importance of early CMR in diagnosis, and management of myocarditis in a patient with IBD.
A 28-year-old male was admitted with a 2-day history of chest pain. Three weeks prior to this presentation, the patient was initiated on mesalazine for UC. Serum troponin T and C-reactive protein were elevated. An echocardiogram showed borderline low left ventricular systolic function (LVEF = 50-55%). A CMR showed extensive patchy late gadolinium enhancement (LGE) in the mid to epicardial basal and mid lateral wall. The findings were consistent with acute myocarditis, and a working diagnosis of mesalazine-induced myocarditis was made. Mesalazine was stopped and guideline-directed anti-inflammatories initiated. Oral prednisolone was also introduced for IBD control. Follow-up CMR at four months showed near complete resolution of LGE.
Myocarditis in the context of IBD may be infective, immune-mediated or due to mesalazine hypersensitivity. Histological conformation was not available in this case. This case report highlights the importance of access to early CMR in order establish the diagnosis and withdrawal of the culprit medication. In the majority of cases, CMR will replace the need for endomyocardial biopsy; however, this may still be required in the most severe cases.
美沙拉嗪是治疗炎症性肠病（IBD）的既定一线疗法，仍是轻度至中度溃疡性结肠炎（UC）的主要治疗药物。美沙拉嗪和UC都是罕见但已被认可的心肌心包炎病因。心脏磁共振成像（CMR）是评估心肌心包炎的一种非侵入性方法。本病例报告强调了早期CMR在IBD患者心肌炎诊断和管理中的重要性。
一名28岁男性因胸痛2天入院。此次就诊前三周，该患者开始使用美沙拉嗪治疗UC。血清肌钙蛋白T和C反应蛋白升高。超声心动图显示左心室收缩功能临界低（左心室射血分数[LVEF]=50-55%）。CMR显示中至心外膜基底和中外侧壁广泛片状延迟钆增强（LGE）。这些发现与急性心肌炎一致，因此做出了美沙拉嗪诱发心肌炎的初步诊断。停用美沙拉嗪，并开始使用指南指导的抗炎药物。还引入了口服泼尼松龙以控制IBD。四个月后的随访CMR显示LGE几乎完全消退。
IBD背景下的心肌炎可能是感染性、免疫介导的或由于美沙拉嗪过敏。本病例无法获得组织学证实。本病例报告强调了早期进行CMR以确立诊断和停用可疑药物的重要性。在大多数情况下，CMR将取代心内膜心肌活检的必要性；然而，在最严重的病例中可能仍需要进行心内膜心肌活检。
