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Myocarditis in Crohn's disease: a case report.
Lucy McGrath-Cadell1,2, Nicole K Bart1, Linda Lin1
1Department of Cardiology, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, 2010 NSW, Australia.
European Heart Journal. Case Reports
|September 25, 2020
Summary
Mobile valvular masses can mimic infective endocarditis. This case highlights myocarditis secondary to Crohn's disease, diagnosed using cardiac magnetic resonance (CMR) imaging, demonstrating the importance of multi-modality imaging in complex cases.
Area of Science:
- Cardiology
- Gastroenterology
- Inflammatory Diseases
Background:
- Mobile valvular masses are typically associated with infective endocarditis.
- Crohn's disease is a chronic inflammatory bowel disease with potential extra-intestinal manifestations.
- Cardiac involvement in Crohn's disease is rare but possible.
Observation:
- A young woman with a history of ileal Crohn's disease presented with symptoms suggestive of endocarditis.
- Initial echocardiography revealed mobile valvular masses, leading to empirical antibiotic treatment for infective endocarditis.
- Despite treatment, the patient remained febrile, prompting further investigation.
Findings:
- Cardiac magnetic resonance (CMR) imaging was crucial in diagnosing myocarditis.
- The valvular masses were ultimately attributed to myocarditis secondary to active Crohn's disease, not infective endocarditis.
- The patient responded well to steroids and anticoagulation therapy.
Implications:
- This case underscores that mobile valvular masses are not exclusively pathognomonic for infective endocarditis.
- Multi-modality imaging, particularly CMR, is essential for accurate diagnosis in complex cardiovascular presentations.
- It highlights a rare but significant association between Crohn's disease and myocarditis presenting with valvular lesions.
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