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Acute Myopericarditis in the Setting of Crohn's Colitis: Challenging Management Decisions
Jordan Daloya1, Aqsa Ashraf1, Alan Kaell2
1Internal Medicine, Zucker School of Medicine/Northwell Health, Mather Hospital, Port Jefferson, USA.
Cureus
|April 11, 2022
Summary
Myopericarditis, a rare Crohn's disease complication, can be challenging to diagnose when patients are on specific medications. This case highlights the diagnostic complexities of myopericarditis in a Crohn's patient with active gastrointestinal disease.
Area of Science:
- Gastroenterology
- Cardiology
Background:
- Crohn's disease (CD) management involves medications like mesalamine and tumor necrosis factor inhibitors (TNFi).
- Myopericarditis is a rare extraintestinal manifestation of CD, and can also be a side effect of CD treatments.
- Differentiating between these causes is crucial for patient management.
Observation:
- A 34-year-old male with CD, previously controlled on mesalamine and infliximab, presented with abdominal pain, bloody diarrhea, chest discomfort, and fever.
- Recent colonoscopy confirmed active colonic CD.
- The patient had recently discontinued TNFi therapy and was intermittently using mesalamine.
Findings:
- Electrocardiogram (ECG) showed evidence of pericarditis.
- Cardiac biomarkers were elevated.
- Ventriculography revealed reduced left ventricular function, consistent with acute myopericarditis.
Implications:
- This case underscores the diagnostic challenges in patients with CD experiencing myopericarditis.
- It highlights the need to consider active gastrointestinal Crohn's disease as a potential cause of myopericarditis.
- Careful differential diagnosis and management strategies are essential in such complex cases.
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