Acute severe ulcerative colitis flare complicated by myopericarditis and infliximab-induced hepatitis
  • Magdalini Manti
    Department of Gastroenterology, St Mark’s Hospital, London, UK
  • Nikolaos Kamperidis
    Department of Gastroenterology, St Mark’s Hospital, London, UK
  • Alexandros Toskas
    Department of Gastroenterology, St Mark’s Hospital, London, UK
  • Harry Martin
    Department of Gastroenterology, St Mark’s Hospital, London, UK
  • Ravi Misra
    Department of Gastroenterology, St Mark’s Hospital, London, UK

Keywords

IBD, myopericarditis, CMV, infliximab, transaminitis

Abstract

Ulcerative colitis (UC) is an autoimmune disease associated with both intestinal and extraintestinal manifestations. The latter may include heart complications, such as myopericarditis leading to life-threatening arrythmias. Nowadays, UC is commonly treated with biologic medications and infliximab is the first line therapy in an outpatient setting, while it is also used as rescue therapy in acute severe UC. However, it has been associated with severe immunosuppression, cytomegalovirus (CMV) reactivation and drug-induced hepatitis. We report a case of UC flare in a biologic naïve patient admitted with myopericarditis, which was further complicated by positive CMV biopsies and infliximab-induced transaminitis.

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References

  • Bunu D-M, Timofte C-E, Ciocoiu M, Floria M, Tarniceriu C-C, Barboi O-B, et al. Cardiovascular manifestations of inflammatory bowel disease: pathogenesis, diagnosis, and preventive strategies. Gastroenterol Res Pract 2019;2019:3012509.
  • Bhardwaj A, Singh A, Midha V, Sood A, Wander GS, Mohan B, et al. Cardiovascular implications of inflammatory bowel disease: an updated review. World J Cardiol 2023;15:553–570.
  • Giordani AS, Candelora A, Fiacca M, Cheng C, Barberio B, Baritussio A, et al. Myocarditis and inflammatory bowel diseases: a single-center experience and a systematic literature review. Int J Cardiol 2023;376:165–171.
  • Hedin CRH, Vavricka SR, Stagg AJ, Schoepfer A, Raine T, Puig L, et al. The pathogenesis of extraintestinal manifestations: implications for IBD research, diagnosis, and therapy. J Crohns Colitis 2019;13:541–554.
  • Nakase H, Herfarth H. Cytomegalovirus colitis, cytomegalovirus hepatitis and systemic cytomegalovirus infection: common features and differences. Inflamm Intest Dis 2016;1:15–23.
  • Jones A, McCurdy JD, Loftus EV Jr, Bruining DH, Enders FT, Killian JM, et al. Effects of antiviral therapy for patients with inflammatory bowel disease and a positive intestinal biopsy for cytomegalovirus. Clin Gastroenterol Hepatol 2015;13:949–955.
  • Rahier JF, Magro F, Abreu C, Armuzzi A, Ben-Horin S, Chowers Y, et al. Second European evidence-based consensus on the prevention, diagnosis and management of opportunistic infections in inflammatory bowel disease. J Crohns Colitis 2014;8:443–468.
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    Published: 2024-03-01
    Issue: 2024: Vol 11 No 4 (view)


    How to cite:
    1.
    Manti M, Nikolaos Kamperidis, Alexandros Toskas, Harry Martin, Ravi Misra. Acute severe ulcerative colitis flare complicated by myopericarditis and infliximab-induced hepatitis. EJCRIM 2024;11 doi:10.12890/2024_004383.

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