P0364 - Mesalamine or Ulcerative Colitis Which One Induced Myocarditis: A Case Report

Taraneh Honarparvar, MD¹, Bartu Avci, MD¹, Danielle D.. Wilson, DO², Lissette Pola, DO^1
1Nova Southeastern University, Wellington, FL; ²Providence Redwood Memorial, Fortuna, CA

Introduction: Myocarditis is an inflammation of the myocardial layer of the heart. It is a clinical syndrome, and an inflammation secondary to infection (such as viral, bacterial, fungal), inflammatory diseases of the other organs such as inflammatory bowel disease (IBD), autoimmune disease, toxins, and medications' adverse effects. Mesalamine is a 5-aminosalicylate medication that can cause myocarditis. This medication is indicated in patients with mild to moderate ulcerative colitis sometimes as the first-line treatment. Mesalamine-induced myocarditis is rare but can be fatal. In addition, inflammatory diseases such as ulcerative colitis can have extra-intestinal complications such as myocarditis.

Case Description/Methods: We report a case of a white male with past medical history of ulcerative colitis (UC) who presented with a chief complaint of typical chest pain. Patient's latest UC's flare up was three weeks before this admission when he was started on Mesalamine. Laboratory results revealed an elevated troponin and N-terminal prohormone of brain natriuretic peptide levels. Electrocardiography (ECG) was unremarkable. Echocardiogram revealed a new onset of heart failure with reduced ejection fraction. Patient was started on medical management with the diagnosis of non ST elevation myocardial infarction however his symptoms continued and repeated ECG revealed diffuse ST elevation in less than 12 hours. Patient underwent the left heart catheterization and coronary artery disease was ruled out. Patient's chest pain improved after discontinuation of Mesalamine and the initiation of high dose corticosteroids.

Discussion: Mesalamine-induced myocarditis can be a fatal complication. Therefore, it should be included in the differential diagnosis for patients with IBD who are on Mesalamine and present with new-onset chest pain. Prompt discontinuation of Mesalamine and initiation of corticosteroids can effectively control symptoms especially if extra-intestinal manifestations of IBD are suspected or during a flare-up episode. While many facilities, including ours, lack cardiac magnetic resonance devices to confirm the diagnosis, this should not delay appropriate management in these patients. This case report underscores the importance of recognizing mesalamine-induced myocarditis and the extra-intestinal manifestations of IBD, such as myocarditis, in patients with typical chest pain.


Disclosures:


Taraneh Honarparvar, MD¹, Bartu Avci, MD¹, Danielle D.. Wilson, DO², Lissette Pola, DO¹. P0364 - Mesalamine or Ulcerative Colitis Which One Induced Myocarditis: A Case Report, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.