Acute Severe Ulcerative Colitis Flare Complicated by Myopericarditis and Infliximab-Induced Hepatitis.

Q3 Medicine

European journal of case reports in internal medicine Pub Date : 2024-03-04 eCollection Date: 2024-01-01 DOI:10.12890/2024_004383

Magdalini Manti, Nikolaos Kamperidis, Alexandros Toskas, Harry Martin, Ravi Misra

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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.

Learning points: In acute inflammatory bowel disease (IBD) flare presentation with tachycardia and chest pain, an underlying myocardial injury should be investigated.Mucosal healing should be evaluated endoscopically in cases of partial response to biologics.Both cytomegalovirus (CMV) infection and infliximab-induced liver injury may lead to acute hepatitis.

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急性重度溃疡性结肠炎复发并发心肌炎和英夫利西单抗诱发肝炎

溃疡性结肠炎（UC）是一种与肠道和肠道外表现相关的自身免疫性疾病。后者可能包括心脏并发症，如心肌炎导致危及生命的心律失常。目前，UC 通常采用生物药物治疗，英夫利昔单抗是门诊治疗的一线药物，也可用于急性重症 UC 的抢救治疗。然而，英夫利昔单抗与严重的免疫抑制、巨细胞病毒（CMV）再激活和药物性肝炎有关。我们报告了一例因心肌炎入院的生物制剂天真患者的 UC 复发病例，该病例因 CMV 活检阳性和英夫利昔单抗诱发的转氨酶炎而进一步复杂化：学习要点：对于急性炎症性肠病（IBD）复发并伴有心动过速和胸痛的患者，应检查是否存在潜在的心肌损伤。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European journal of case reports in internal medicine

CiteScore

2.10

自引率

0.00%

发文量

166

审稿时长

8 weeks

期刊介绍： The European Journal of Case Reports in Internal Medicine is an official journal of the European Federation of Internal Medicine (EFIM), representing 35 national societies from 33 European countries. The Journal''s mission is to promote the best medical practice and innovation in the field of acute and general medicine. It also provides a forum for internal medicine doctors where they can share new approaches with the aim of improving diagnostic and clinical skills in this field. EJCRIM welcomes high-quality case reports describing unusual or complex cases that an internist may encounter in everyday practice. The cases should either demonstrate the appropriateness of a diagnostic/therapeutic approach, describe a new procedure or maneuver, or show unusual manifestations of a disease or unexpected reactions. The Journal only accepts and publishes those case reports whose learning points provide new insight and/or contribute to advancing medical knowledge both in terms of diagnostics and therapeutic approaches. Case reports of medical errors, therefore, are also welcome as long as they provide innovative measures on how to prevent them in the current practice (Instructive Errors). The Journal may also consider brief and reasoned reports on issues relevant to the practice of Internal Medicine, as well as Abstracts submitted to the scientific meetings of acknowledged medical societies.

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