CONGRESS ABSTRACT

Ulcerative colitis (UC) is primarily a gastrointestinal disorder, but 25–40% of patients may develop extraintestinal manifestations. Cardiac involvement is rare (<1%), with pericarditis and, more infrequently, myocarditis. Mesalazine is a common first-line therapy for mild-to-moderate UC and is generally well tolerated, though rare cases of drug-induced myopericarditis have been described. Distinguishing UC-related cardiac inflammation from mesalazine-induced toxicity can be challenging. Awareness of this uncommon adverse reaction is essential, as prompt withdrawal of mesalazine and initiation of anti-inflammatory treatment can facilitate recovery of cardiac function and help prevent further complications. We report the case of a 20-year-old male with a recent diagnosis of UC treated with oral mesalazine, who presented to the emergency department with pharyngeal pain, intermittent low-grade fever, and recurrent chest pain. Laboratory tests showed mild anemia and hypokalemia, neutrophilic leukocytosis, elevated transaminases, troponin I (994 pg/mL), NT-proBNP (5404 pg/mL) and CRP. Electrocardiography revealed tachycardia with ST-segment elevation and T-wave inversion in the inferior leads (Figure 3). Echocardiography showed hypokinesia of the mid-distal inferior septum and mid anterolateral and posterior walls, mild left ventricular systolic dysfunction (LVEF 44%), moderate mitral regurgitation, and a non-tamponade pericardial effusion. The patient was admitted to the Cardiology Unit. Cardiac CT excluded coronary artery disease. Infectious etiologies were ruled out. Suspecting mesalazine-induced myopericarditis, the drug was promptly discontinued. The patient was started on ibuprofen, colchicine, low-dose bisoprolol and potassium canrenoate. Cardiac MRI revealed myocardial edema with subepicardial late gadolinium enhancement in the inferolateral walls (Figure 1 and 2), supporting the diagnosis of myopericarditis. Endomyocardial biopsy was not performed given the low-risk status of the patient. Upon clinical stabilization, 30 days later the patient was discharged asymptomatic and with normalization of inflammatory and myocardial injury markers. LVEF improved to 60% This case highlights a rare association between mesalazine therapy and acute myopericarditis in young patients with ulcerative colitis. Discontinuation of mesalazine and early administration of anti-inflammatory therapy is associated with clinical recovery and normalization of cardiac function.