P2724 - Ustekinumab-Induced Myocarditis in a Patient With Crohn's Disease

Sayel Alzraikat, MD¹, Qusai Al Zureikat, MD¹, Usman Afzal, MD², Amer Arman, MD¹, Spyros Peppas, MD³, Ripple Mehta, MD⁴, Nikiya Asamoah, MD^5
1MedStar Health-Georgetown/Washington Hospital Center, Washington, DC; ²Washington Hospital Center, Washington, DC; ³MedStar Washington Hospital Center, Washington, DC; ⁴MedStar Georgetown University Hospital, Washington, DC; ⁵MedStar Health, Washington, DC

Introduction: Ustekinumab, a monoclonal antibody inhibiting interleukin-12/23 signaling, is an effective treatment for autoimmune conditions, including Crohn's disease, thought to have a better safety profile compared to other biologic therapies. The case below presents, to our knowledge, the first case of acute onset myocarditis after Ustekinumab therapy.

Case Description/Methods: A 28-year-old male, diagnosed with ileocolonic Crohn's disease in early 2023, and no prior cardiac history presented with fatigue, exercise intolerance, tachycardia, and chest pain 10 days after starting Ustekinumab. On presentation to an outside hospital, he had clinical markers indicative of non-ST elevation myocardial infarction (NSTEMI), with significantly elevated troponins and inflammatory markers. An echocardiogram showed normal cardiac function. Myocarditis was suspected, and infectious workup confirmed a group A streptococcal infection. Treatment with antibiotics, colchicine, metoprolol, and losartan led to gradual symptom resolution.

After receiving the second Ustekinumab dose on 6/27, he presented to another hospital approximately 14 days later with recurrent chest pain and exercise intolerance. Labs suggested NSTEMI, with troponins peaking at 77,000. He was transferred to our tertiary care center for further evaluation. Extensive cardiac evaluation with normal findings, including left and right heart catheterization, infectious and autoimmune workup, and inconclusive endomyocardial biopsy, followed. Cardiac MRI revealed preserved left ventricular function and mildly reduced right ventricular function, with late gadolinium enhancement (LGE) and edema in both ventricles, consistent with myocarditis affecting multiple areas. Genetic testing ruled out underlying genetic cardiomyopathy. He received corticosteroid therapy and was discharged with a Zio patch for monitoring and planned for immunosuppressive therapy.

Discussion: The temporal relationship between Ustekinumab administration and symptom onset, coupled with the exclusion of other causes, strongly suggests Ustekinumab-induced myocarditis. Similar cases link immune-modulating therapies to myocarditis. This case highlights the need for clinicians to consider myocarditis in patients with cardiac symptoms post immune-modulating therapy administration, enabling early recognition and management, including immunosuppressive therapy for more favorable outcomes.


Disclosures:


Sayel Alzraikat, MD¹, Qusai Al Zureikat, MD¹, Usman Afzal, MD², Amer Arman, MD¹, Spyros Peppas, MD³, Ripple Mehta, MD⁴, Nikiya Asamoah, MD⁵. P2724 - Ustekinumab-Induced Myocarditis in a Patient With Crohn's Disease, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.