SHM Converge Scientific Abstract ePoster Gallery-Mesalamine-Induced Pericarditis: A Case Report

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This case report describes a 29-year-old man with newly diagnosed mild ulcerative colitis who developed mesalamine-induced pericarditis shortly after starting treatment. He began oral mesalamine at 4.8 g/day and, two weeks later, presented with dull chest pain that worsened with inspiration and improved when leaning forward, consistent with pericarditis. He was tachycardic but otherwise stable, and cardiac examination was normal. Laboratory tests showed leukocytosis, elevated C-reactive protein, and increased troponins. ECG demonstrated inferior ST-segment elevations, while echocardiography showed normal ventricular function and no pericardial effusion.<br /><br />Given the concern for a drug-related cardiac reaction, mesalamine was stopped and the patient was treated with prednisone and colchicine. He improved rapidly, with complete resolution of chest pain and no complications. He was discharged on prednisone and colchicine, and later transitioned to ustekinumab for ulcerative colitis management. At follow-up, he remained well without recurrent chest pain.<br /><br />The report highlights that pericarditis and myocarditis can occur in inflammatory bowel disease, either as extra-intestinal manifestations or as adverse effects of therapies such as 5-aminosalicylates and TNF-alpha antagonists. In this case, the timing after mesalamine initiation and improvement after discontinuation strongly supported a medication-induced cause. The authors emphasize that stopping the offending drug is the best management approach and that patient education is important for early recognition of symptoms.

Asset Subtitle

Ahmed Ibrahim

Meta Tag

Author List Abdul Sattar Shariq Mohammed, Ahmed Ibrahim, Aimen Farooq, Amir Harb, Ilan Aharoni, Muhammad Zaeem, Nouman Shafique, Tareq Alsaleh

Category Clinical Vignettes

Concept Pericarditis

Concept Mesalamine

Concept Inflammatory Bowel Disease

Concept Adverse Drug Reaction

Concept Pleuritic Chest Pain

Distinguished Non-Finalist

Presenter Organization Internal Medicine, AdventHealth Orlando

Presenting Author Ahmed Ibrahim

Track Adult

Keywords

ulcerative colitis

mesalamine

pericarditis

myocarditis

drug-induced

chest pain

5-aminosalicylates

troponin elevation

prednisone

colchicine

Pericarditis

Mesalamine

Inflammatory Bowel Disease

Adverse Drug Reaction

Pleuritic Chest Pain