Acute Severe Ulcerative Colitis Flare Complicated by Myopericarditis and Infliximab-Induced Hepatitis

Area of Science:

• Gastroenterology
• Immunology
• Cardiology

Background:

• Ulcerative colitis (UC) is an autoimmune disease with potential systemic complications.
• Extraintestinal manifestations of UC can include cardiac issues like myopericarditis.
• Biologic therapies, such as infliximab, are common UC treatments but carry risks like immunosuppression and drug-induced hepatitis.

Purpose of the Study:

• To report a case of ulcerative colitis flare presenting with myopericarditis.
• To illustrate complications including cytomegalovirus (CMV) reactivation and infliximab-induced liver injury.

Main Methods:

• Case report of a biologic-naïve patient with ulcerative colitis flare.
• Clinical presentation, diagnostic workup including biopsies, and treatment course.

Main Results:

• Patient admitted with myopericarditis during a UC flare.
• Positive CMV biopsies and subsequent diagnosis of infliximab-induced transaminitis.
• Demonstration of complex interplay between UC, cardiac complications, CMV, and iatrogenic liver injury.

Conclusions:

• Investigate myocardial injury in inflammatory bowel disease flares presenting with tachycardia and chest pain.
• Endoscopic evaluation is crucial for assessing mucosal healing with partial biologic response.
• Cytomegalovirus infection and infliximab-induced liver injury can both cause acute hepatitis.