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210 MYOCARDITIS AS AN EXTRAINTESTINAL MANIFESTATION OF INFLAMMATORY BOWEL DISEASE (IBD): A CASE REPORT AND REVIEW OF THE LITERATURE MB Jones, GR Greenberg Cardiac extraintestinal manifestations in inflammatory bowel disease are rare and include myocarditis. Although often associated with disease activity, myocarditis has also been described in patients with inactive disease and prior to the diagnosis of IBD. An improvement in cardiorespiratory symptoms and left ventricular function has been observed in patients with IBD-associated myocarditis following treatment with corticosteroids.
Mount Sinai Hospital, University of Toronto, Toronto, Ontario
In this report, we describe a 28 year old man who presented to hospital with a one month history of bloody diarrhea. A CTscan of his abdomen revealed marked circumferential thickening of his entire colon and a moderate pericardial effusion. Colonoscopy revealed continuous inflammation from the rectum to the mid-ascending colon. Biopsies taken from the colon revealed acute and chronic inflammation consistent with ulcerative colitis. 2-D echocardiography confirmed the presence of a moderate pericardial effusion.
The patient was prescribed a combined 5-ASA and corticosteroid enema and oral 5-ASA (4.5 g/day). After initial improvement, he subsequently developed worsening abdominal complaints and new symptoms of fever, shortness of breath and chest pain. The patient was transferred to the intensive care unit upon further deterioration in his cardiorespiratory status.
The patient's stay in the intensive care unit was complicated by ventricular fibrillation requiring defibrillation and amiodarone. 2-D echocardiography revealed global hypokinesis and grade 3-4 left ventricular function. An endomyocardial biopsy demonstrated myocarditis. Intravenous steroids were initiated and rapid clinical improvement in both gastrointestinal and cardiorespiratory symptoms were observed. Repeat 2-D echocardiography performed approximately one week after treatment with intravenous steroids revealed grade 1-2 left ventricular function and a reduced pericardial effusion.
Although myocarditis is a rare extraintestinal manifestation of IBD, it can have significant consequences if not recognized, including fatal arrhythmias, and requires systemic corticosteroid therapy. Gastroenterologists should remain aware of this association in patients with IBD presenting with cardiorespiratory symptomatology.