P2741 - Hiding in Plain Sight: A Rare Cardiac Complication of Ulcerative Colitis

Sarah Barbina, MD, Richard Bloomfeld, MD
Atrium Health Wake Forest Baptist, Winston-Salem, NC

Introduction: Extraintestinal cardiac manifestations are common in Inflammatory Bowel Disease (IBD) and cardiac manifestations, such as pericarditis and myocarditis, have been described. Libman-Sach's endocarditis (LSE) or nonbacterial thrombotic endocarditis is associated with antiphospholipid syndrome or malignancy. The aortic and mitral valves are commonly affected and patients often suffer embolic cerebral vascular accidents. We present a rare case of Ulcerative Colitis (UC) associated with LSE.

Case Description/Methods: A 20-year-old man with history of pancolonic UC initially diagnosed 3 years ago was admitted with chest pain. He has lived with refractory UC which had not responded to multiple biologics. Evaluation of chest pain included an elevated troponin to 800 pg/ml and echocardiogram that showed a small pericardial effusion. He was diagnosed with pericarditis/myocarditis and discharged with improving symptoms on colchicine and ibuprofen.



Two weeks later, he presented to the ED with worsening hematochezia and diarrhea. His laboratory work-up revealed hemoglobin 6.3 g/dl, CRP 92 mg/L, and fecal calprotectin of 4980 ug/g. A CT scan showed diffuse colonic wall thickening and a new inferior vena cava thrombus. He was initiated on a heparin drip and intravenous (IV) steroids which was quickly transitioned to oral prednisone.



After 5 days, he developed new lower extremity edema. Transesophageal echocardiogram revealed aortic and mitral valve vegetations with moderate aortic and severe mitral regurgitation with possible leaflet perforation. Flexible sigmoidoscopy showed diffuse Mayo grade 3 colitis to the level of examined sigmoid colon. IV steroids were restarted. Although all blood cultures remained negative, he was treated with empiric IV antibiotics. Two days later, brain MRI showed acute embolic infarcts. After multidisciplinary discussions, the decision was made to pursue proctocolectomy for steroid-refractory UC associated with Libman-Sachs endocarditis. His cardiac disease will be followed post-operatively to decide whether valvular surgery is required.

Discussion: One other case of LSE associated with IBD has been reported. In that case, the patient presented with cerebral embolic infarcts and underwent cardiothoracic surgery with valve repair. Patients with IBD can present with cardiac extra-intestinal manifestations. Additionally, it is known that patients with IBD are hypercoagulable, and LSE is associated with hypercoagulable states. This case represents a rare association of LSE with IBD.



Disclosures:


Sarah Barbina, MD, Richard Bloomfeld, MD. P2741 - Hiding in Plain Sight: A Rare Cardiac Complication of Ulcerative Colitis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.