Wang YY, Shi W, Wang J, Li Y, Tian Z, Jiao Y. Myocarditis as an extraintestinal manifestation of ulcerative colitis: A case report and review of the literature. World J Clin Cases 2022; 10(27): 9750-9759 [PMID: 36186201 DOI: 10.12998/wjcc.v10.i27.9750]
Corresponding Author of This Article
Yang Jiao, MD, Associate Professor, Department of General Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifu Yuan, Dongcheng District, Beijing 100730, China. peterpumch@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
You-Yang Wang, Yang Jiao, Department of General Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
Wen Shi, Yue Li, Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
Jian Wang, Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
Zhuang Tian, Department of Cardiology and International Medical Service, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
Author contributions: All authors were involved in the care of the patient. Wang YY and Wang J wrote the initial draft of the manuscript; Shi W, Li Y, Tian Z, and Jiao Y critically appraised and revised the overall content of the manuscript; and all authors read and approved the final manuscript.
Supported byChina Medical Board Open Competition Program, No. 20-384; and National Major Science and Technology Projects of China, No. 2020YFC0841300.
Informed consent statement: Informed written consent was obtained from the patient’s legal guardian for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yang Jiao, MD, Associate Professor, Department of General Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifu Yuan, Dongcheng District, Beijing 100730, China. peterpumch@163.com
Received: January 2, 2022 Peer-review started: January 2, 2022 First decision: March 10, 2022 Revised: March 25, 2022 Accepted: August 14, 2022 Article in press: August 14, 2022 Published online: September 26, 2022 Processing time: 257 Days and 10.4 Hours
Abstract
BACKGROUND
Although extraintestinal manifestations of inflammatory bowel disease (IBD) are well documented, myocarditis has only rarely been reported as an extraintestinal manifestation, and it can be fatal. The various clinical presentations and causes of myocarditis in IBD patients complicate making a correct and timely diagnosis.
CASE SUMMARY
Here we report a 15-year-old boy who presented with myocarditis as the initial presentation of a relapse of ulcerative colitis. In reviewing the literature for cases of myocarditis complicating IBD, we found 21 other cases, allowing us to expand our understanding of the clinical presentation, diagnosis, management, and outcomes of this rare condition. The most frequent diagnostic clues for myocarditis in IBD patients are dyspnea, chest pain, tachycardia, raised cardiac biomarkers, and abnormalities on trans-thoracic echocardiography. Additionally, we discuss the etiology of myocarditis in IBD patients, which include an extraintestinal manifestation, the adverse effects of mesalamine and infliximab, selenium deficiency, and infection, to help provide a framework for diagnosis and management.
CONCLUSION
Myocarditis as an extraintestinal manifestation of IBD can be life-threatening. Trans-thoracic echocardiogram and cardiac magnetic resonance may assist its diagnosis.
Core Tip: While the extraintestinal manifestations (EIM) of inflammatory bowel disease (IBD) are well documented, myocarditis as an EIM of IBD is rare. Here we present the case of a 15-year-old boy who presented with myocarditis as the initial presentation of a relapse of ulcerative colitis. The case was unusual in that: (1) While the gastrointestinal symptoms were mild, the endoscopic severity was severe; and (2) He only had mild cardiac symptoms and minimal ventricular dysfunction except for acute chest pain. We therefore propose that cardiovascular manifestations of IBD may be more common than clinically documented, since they may remain undiagnosed.
