• Cardiovascular disorders
• Chronic inflammation
• Endothelial dysfunction
• Inflammatory bowel diseases
• Oxidative stress
• Pericarditis
• Thromboembolism
• myocarditis

• atypical chest pain
• chest pain
• dyspnea
• inspiratory dyspnea
• mesalamine
• recurrent pericarditis

Inflammatory bowel disease (IBD) is a chronic condition of the bowel that can be further categorized into ulcerative colitis and Crohn’s disease. Rarely, this condition can be associated with pericarditis, which can be an extraintestinal manifestation of the disease or drug-induced. This review aims to determine the pathogenesis and management of pericarditis in IBD. In this review, the goal is to elucidate the pathogenesis of pericarditis in IBD and determine if pericarditis is an extraintestinal manifestation of IBD or a complication of current drug therapy used to manage IBD. Additionally, this review intends to explain the first-line management of pericarditis in IBD and explore the role of biologicals in attenuating pericarditis. An electronic search was conducted to identify relevant reports of pericarditis in IBD, and a quality assessment was conducted to identify high-quality articles according to the inclusion criteria. Full-text articles from inception to November 2020 were included, while non-English articles, gray literature, and animal studies were excluded. The majority of studies suggest that pericarditis arises as a complication of drug therapy by 5-aminosalicylic acid derivatives such as sulfasalazine, mesalamine, and balsalazide, and it occurs due to IgE-mediated allergic reactions, direct cardiac toxicity, cell-mediated hypersensitivity reactions, and humoral antibody response to therapy. Drug cessation or the initiation of a corticosteroid regimen seems to be the most effective means of managing pericarditis in IBD due to drug therapy or an extraintestinal manifestation.

• crohn’s disease
• extraintestinal manifestations
• inflammatory bowel disease
• pericarditis
• ulcerative colitis

Inflammation of the myocardium (myocarditis) or pericardium (pericarditis) or both (myopericarditis) as side effects of mesalamine, a drug widely used in the treatment of inflammatory bowel disease, is a rare, but potentially lethal complication. We report a case of myopericarditis occurring in a young Caucasian woman 14 days following initiation of mesalamine therapy for treatment of a newly diagnosed ulcerative colitis (UC). She presented with pleuritic chest pain, elevated troponin levels and pre-syncope. The diagnosis of myopericarditis was made based on the clinical features, electrocardiogram (EKG) and cardiac magnetic resonance, which showed trace pericardial effusion. The patient’s symptom and condition were dramatically improved upon discontinuing mesalamine, and a full recovery was achieved. Mesalamine-induced inflammation of the myocardium (myocarditis) or pericardium (pericarditis) or both (myopericarditis) is rare, but has fatal side effects. Early recognition of these side effects by clinicians and patients is important to prevent progression of the inflammation. Furthermore, patients should be educated to seek urgent medical attention if cardiac symptoms arise.

• CMR
• Chest pain
• Mesalamine
• Myopericarditis
• Ulcerative colitis

• pediatric
• recurrent pericarditis
• ulcerative Colitis

• 5-aminosalicylic acid
• mesalamine
• mesalazine
• myocarditis
• pericarditis

Mesalazine is a 5-aminosalicylic acid derivative that has been widely used to treat patients with inflammatory bowel disease. Accumulating evidence indicates that mesalazine has a very low rate of adverse drug reactions and is well tolerated by patients. However, a few cases of pulmonary and cardiac disease related to mesalazine have been reported in the past, though infrequently, preventing clinicians from diagnosing the conditions early. We describe the case of a 32-year-old man with ulcerative colitis who was admitted with a two-month history of persistent fever following mesalazine treatment initiated 14 mo earlier. At the time of admission, mesalazine dose was increased from 1.5 to 3.0 g/d, and antibiotic therapy was started with no improvement. Three weeks after admission, the patient developed dyspnea, non-productive cough, and chest pain. Severe eosinophilia was detected in laboratory tests, and a computed tomography scan revealed interstitial infiltrates in both lungs, as well as a large pericardial effusion. The bronchoalveolar lavage reported a CD4/CD8 ratio of 0.5, and an increased eosinophil count. Transbronchial biopsy examination showed a severe eosinophilic infiltrate of the lung tissue. Mesalazine-induced cardiopulmonary hypersensitivity was suspected after excluding other possible etiologies. Consequently, mesalazine treatment was suspended, and corticosteroid therapy was initiated, resulting in resolution of symptoms and radiologic abnormalities. We conclude that mesalazine-induced pulmonary and cardiac hypersensitivity should always be considered in the differential diagnosis of unexplained cardiopulmonary symptoms and radiographic abnormalities in patients with inflammatory bowel disease.

• Eosinophilia
• Mesalazine
• Pericardial effusion
• Lung hypersensitivity
• Ulcerative colitis

• Adrenal Cortex Hormones/therapeutic use
• Adult
• Anti-Inflammatory Agents, Non-Steroidal/adverse effects
• Biopsy
• Colitis, Ulcerative/diagnosis
• Colitis, Ulcerative/drug therapy
• Drug Substitution
• Humans
• Male
• Mesalamine/adverse effects
• Pericardial Effusion/chemically induced
• Pericardial Effusion/diagnosis
• Predictive Value of Tests
• Pulmonary Eosinophilia/chemically induced
• Pulmonary Eosinophilia/diagnosis
• Remission Induction
• Respiratory Hypersensitivity/chemically induced
• Respiratory Hypersensitivity/diagnosis
• Risk Factors
• Severity of Illness Index
• Tomography, X-Ray Computed
• Treatment Outcome

Cardiac tamponade is a rare extraintestinal manifestation of ulcerative colitis. We present a case report of tamponade occurring four years after curative proctocolectomy and in the absence of any medical therapy for ulcerative colitis. Options for medical management of this condition are also discussed.

• Crohn Disease/complications
• Crohn Disease/therapy
• Endocarditis, Bacterial/etiology
• Endocarditis, Bacterial/therapy
• Enterococcus faecalis/isolation & purification
• Female
• Humans
• Middle Aged