The Vulnerability of the Heart During Diarrhea: A Case Report on Pericarditis Linked to Inflammatory Bowel Disease

Inflammatory bowel disease (IBD), encompassing ulcerative colitis (UC) and Crohn's disease, often involves extraintestinal manifestations, affecting up to 40% of patients. Cardiovascular complications, although rare, can include pericarditis, the most common cardiac manifestation in IBD.

We report the case of a 34-year-old male with a long-standing history of UC who presented with pleuritic chest pain, shortness of breath, and worsening colitis symptoms. This case is particularly noteworthy due to the complexity added by the patient's 24-year history of UC, diverse treatment modalities (including mesalamine, 6-mercaptopurine, infliximab, vedolizumab, upadacitinib, and ustekinumab), and the patient not being on any 5-aminosalicylic acid (5-ASA) medications known to cause pericarditis at the time of presentation. The pericarditis episodes were temporally associated with UC flare-ups, complicating the distinction between disease-induced and medication-induced pericarditis. The patient experienced two recurrent episodes within 14 weeks, and comprehensive investigations excluded other common causes, narrowing down the potential etiologies. Clinical evaluation revealed pericarditis with a moderate pericardial effusion, elevated inflammatory markers, and normal cardiac biomarkers. The patient's pericarditis was managed with corticosteroids and colchicine, leading to rapid symptom resolution. This case underscores the challenge of distinguishing between disease-induced and medication-induced pericarditis in IBD patients.

Pericarditis, although a rare extraintestinal manifestation of IBD, should be considered in patients with UC presenting with chest pain. This report highlights the need for heightened awareness and careful management of pericarditis in UC patients. Clinicians should maintain a high index of suspicion for cardiovascular complications in IBD, ensuring timely diagnosis and intervention.