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Recurrent pericarditis in a patient with ulcerative proctitis due to mesalazine suppositories

Authors :
Francisco José Morera
María Dolores de las Marinas
Antonio Salvador
Francisco Javier Landete
Juan Carlos Bernal-Sprekelsen
Source :
International Journal of Colorectal Disease. 25:1143-1144
Publication Year :
2010
Publisher :
Springer Science and Business Media LLC, 2010.

Abstract

Dear Editor: Pericarditis is rarely reported in inflammatory bowel disease (IBD). The most frequent presentation is as acute pericarditis. It can arise as a true extraintestinal IBD event or as a secondary effect due to drug employment. We present a case of a recurrent pericarditis related to ulcerative colitis (UC) and induced with suppositories of mesalazine. A 54-year-old male was seen as an outpatient with scarce bloody diarrhea during the past 6 months. Clinical history reported hypertension, colecystectomy with adenocarcinoma in situ 7 years ago, upper gastrointestinal bleeding treated medically due to gastritis and a lupus-like reaction 20 years ago. Recently, diagnosed and treated with metformine due to diabetes type 2. The performance of a colonoscopy revealed a continuously inflamed mucosa up to the rectosigmoid junction and proven histology of UC without displastic lesions. Corticoid foamwas initiated for 2 weeks and then switched to mesalazine 1.5 g orally a day. After 3 weeks, he was admitted to hospital with chest pain, fatigue, and fever as high as 39oC. With the diagnosis of viral pericarditis, a chest X-ray was ordered and revealed an enlarged cardiac silhouette. Electrocardiogram was normal but echocardiogram detected pericardic effusion in the anterior and posterior space. Among the laboratory data of interest were hemoglobin 15.2 g, leucocytes 9.900 (51.6% neutrophils), eosinophils 0.9%, albumin 41.6 g/L globulin 32.2 g/L (albumin/globulin ratio=1.29), and ferritin 180.7 ng/ml. C-reactive protein 7.89 mg/L (slightly elevated) and erythrocyte sedimentation rate 10 mm. Treatment was commenced with 3 g daily for 7 days of acetilsalycilic acid. Oral mesalazine was stopped in the meanwhile. After the cardiac episode, the patient was managed with 500 mg mesalazine in suppository as maintenance therapy. After 3 weeks, he presented with a second episode of pericarditis. A chest CT revealed a thickened pericardium. Rheumatoid factor, antinuclear, anti-DNA, and antimitochondrial antibodies were negative or in normal range. Complement C3 143 mg/dl, complement C4 23.5 mg/dl, complement CH50 55.5U/mL was in normal ranges. Since the withdrawal of mesalazine no further pericarditis episode developed. Cardiac involvement can be associated with IBD especially with UC being pericarditis the most frequent cardiac feature, although it may affect the myocardium or even both structures. Both cutaneous test with mesalazine and test for linfoblastic proliferation were negative, but do not exclude the diagnosis of drug-induced pericarditis. The gold standard for the diagnosis of drug allergy is a provocation test with the potential agent. This method of course would not be ethical at all and implies a great risk for the patient. J. C. Bernal-Sprekelsen (*) European Board of Coloproctology, Department of General Surgery, Hospital General de Requena, Pasaje Casablanca s/n, 46340 Requena, Spain e-mail: jcbernal@comv.es

Details

ISSN :
14321262 and 01791958
Volume :
25
Database :
OpenAIRE
Journal :
International Journal of Colorectal Disease
Accession number :
edsair.doi...........3bb50a836fa15b4db94ff19f263d82ca
Full Text :
https://doi.org/10.1007/s00384-010-0921-x