Recurrent mesalazine-induced myopericarditis in a patient with ulcerative colitis

Mesalazine is a common treatment for inflammatory bowel disease and can be rarely associated with myopericarditis. We report a case of a 19-year-old man recently diagnosed with ulcerative colitis and started on mesalazine, who presented with chest pain 2 weeks after beginning this therapy. Blood tests demonstrated elevated troponin I. ECG and echocardiographic changes were consistent with myopericarditis. When mesalazine was reintroduced 2 weeks after discharge, he suffered from myopericarditis again. On cessation of the drug, the cardiac symptoms resolved in combination with anti-inflammatory therapy. The onset of symptoms after mesalazine, and improvement of chest pain and cardiac biomarkers after discontinuing the drug, suggest that our patient suffered from a rare drug-hypersensitivity reaction to mesalazine.