AUCTORES
Globalize your Research
case report | DOI: https://doi.org/10.31579/2641-0419/241
1Department of Internal Medicine, Michigan State University, Lansing, MI
2Department of Cardiology, Michigan State University, Lansing, MI
*Corresponding Author: Rohan Prasad, Department of Internal Medicine, Michigan State University, Lansing, MI
Citation: Surya Chennupati, Rohan Prasad, Tyler Kemnic, Abdullah Al-abcha, Manel Boumegouas., et all (2022). Myopericarditis as an Extra-Intestinal Manifestation of Crohn’s Disease: A Case Report. J. Clinical Cardiology and Cardiovascular Interventions, 5(1); DOI:10.31579/2641-0419/241
Copyright: © 2022 Rohan Prasad, This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 30 November 2021 | Accepted: 31 December 2021 | Published: 07 January 2022
Keywords: myopericarditis; crohn’s disease; extra-intestinal
Introduction: Myopericarditis is an uncommon manifestation of Crohn’s disease. Interestingly enough, it can present in a patient without any acute bowel symptoms.
Case Presentation: A 21-year-old male with a medical history of Crohn’s disease and eosinophilic esophagitis presented to the hospital with chest pain and fever. Blood work revealed elevated troponin, C-reactive protein, and sedimentation rate levels. Electrocardiogram (EKG) showed diffuse ST elevation in all leads. Transthoracic echocardiogram (TTE) demonstrated a small pericardial effusion without valvular abnormalities. The patient was diagnosed with myopericarditis. Extensive etiological workup was negative, in the absence of other explanations, it was attributed to his Crohn’s disease. The patient was started on colchicine and ibuprofen. Out-patient follow-up revealed resolution of symptoms.
Conclusion: This case reports the rare occurrence of myopericarditis and Crohn’s disease. Inflammatory bowel disease as a cause of myopericarditis has been reported in some cases within the literature; however, there is no definitive mechanism known.
Abbreviations
EKG: electrocardiogram
IBD : inflammatory bowel disease
TTE : Transthoracic echocardiogram
Introduction
Myopericarditis is defined as inflammation of the pericardium with myocardial involvement.[1] Viral infections are considered the most common etiology of the disease.[2] While uncommon, myopericarditis has been associated as an extra-intestinal manifestation of Crohn’s disease.[3,4,5] Myopericarditis can present without acute bowel manifestations of Crohn’s disease.[6] This case report was prepared following the CARE guidelines [7].
Case Narrative
A 21-year-old male with a medical history of Crohn’s disease and eosinophilic esophagitis presented to the emergency department with chest pain, fever, and difficulty breathing. His Crohn’s disease has been controlled with vedolizumab and azathioprine for two years prior to presentation. He had no significant past surgical, social, or family history. His chest pain was sharp, located beneath the bilateral lower ribcage, worsened with deep breaths, and improved by leaning forward. His symptoms started one day prior to presentation. On presentation, his vital signs showed a temperature of 103 Fahrenheit, heart rate of 103 bpm, but otherwise normal. Cardiopulmonary auscultation revealed an S3 gallop without a pericardial friction rub.
On admission, laboratory work-up revealed a troponin level of 0.13 ng/mL that trended to 17.74 ng/mL, C-reactive protein of 3.3 mg/dL that trended to 5.8mg/dL, and sedimentation rate of 11 that trended to 18 mm/h. The patient had a normal white blood cells count and brain natriuretic peptide. The polymerase chain reaction was negative when the nasopharyngeal specimen was tested for influenza A, influenza B, group A streptococcus, and group C/G streptococcus. Viral serology was negative for Coxsackie A virus, Coxsackie B virus, Adenovirus, Echovirus, Cytomegalovirus, and Epstein Barr virus. Electrocardiogram (EKG) showed diffuse ST elevation in the anterolateral leads (Figure 1).
Computed tomography angiogram of the chest showed no evidence of pulmonary embolism, thoracic aortic disease, pneumothorax, mediastinal lymphadenopathy, or pulmonary infiltrates. Transthoracic echocardiogram (TTE) showed an ejection fraction of 55% with a small pericardial effusion (Figure 2).
The patient was diagnosed with myopericarditis. After consulting with the patient’s gastroenterologist, it was decided that the benefits of a fourteen-day non-steroidal anti-inflammatory with Crohn’s disease outweighed the risks. The patient was then discharged on colchicine (0.6 mg twice daily) alongside ibuprofen (600 mg thrice daily) and was instructed to return if his symptoms worsened or did not resolve. Repeat TTE and pericardial/endomyocardial biopsy were discussed with the patient, but due to the resolution of symptoms with medical management, the patient declined further investigations. During follow-up appointments with his primary care physician, the patient did not report a recurrence of these symptoms (Table 1).
The term myopericarditis indicates a primary pericarditic syndrome with myocardial involvement.[2] It is precipitated by multiple etiologies including infections, malignancy, and autoimmune diseases. Viral infections are the most common etiology.[2] The differential diagnosis of myopericarditis is broad. Viral etiologies were excluded by negative viral serologies. Bacterial pericarditis is very rare in developed nations. Neoplastic etiologies were unlikely due to the patient’s age, clinical presentation, lack of risk factors, and lack of other signs or symptoms associated with malignancies. Autoimmune etiology was high on the differential due to the patient’s age and his history of Crohn’s disease. The presence of two or more out of the following features are needed for the diagnosis of acute pericarditis: chest pain, pericardial friction rub, EKG changes of diffuse ST elevation or PR depression, and pericardial effusion.[8] The clinical diagnosis of myopericarditis requires establishing the diagnosis of pericarditis at first, in addition to elevation of cardiac markers and the absence of new-onset focal or global left ventricular wall motion abnormalities.[8]
Extra-intestinal manifestations of inflammatory bowel disease (IBD) are common and can present before or after the diagnosis of IBD.[9] Joints, eyes, and skin are the most commonly involved organs.[9] Cardiac involvement is rare in IBD, but can include pericarditis, myopericarditis, arrhythmias, and conduction disorders.[10] Pericarditis is the common cardiac complication of IBD.[11] The relative risk of myopericarditis in Crohn’s is 8.3%.[12] Myopericarditis has been linked to IBD and specifically Crohn’s disease in multiple case reports (Table 2). There are two proposed mechanisms to explain the relationship between myopericarditis and Crohn’s disease. The first is an autoimmune-mediated inflammatory response against autoantigens and the second mechanism is related to the toxicity of 5-aminosalicylic acid and its derivatives.[13,14]
similarly to acute pericarditis. For viral or idiopathic pericarditis, non-steroidal anti-inflammatory drugs are the treatment of choice, specifically ibuprofen at 1200-1800 mg daily for days to weeks. Colchicine has been shown to be helpful for acute and recurrent pericarditis as it can decrease the recurrence rate by 50%. Corticosteroids, initially used in the past, are now avoided due to the increased risk of future recurrences. Additionally, intravenous immunoglobulins are not used because of insufficient data to support their use.[2] A case report from 1981 illustrates how corticosteroids were the backbone of the treatment for myopericarditis.[15] A recurrent myopericarditis in 2003, however, was not able to be controlled despite treatment consisting of prednisone, azathioprine, and sulphasalazine.[16] Finally, a 2019 case of acute myopericarditis presented during a Crohn’s flare-up, the treatment used was colchicine with an increase of the patient’s home steroid dose, which resulted in symptomatic relief.[17] Based on current recommendations, we treated our patient with ibuprofen and colchicine.
Conclusion
This case reports the rare occurrence of myopericarditis and Crohn’s disease. Patients with IBD have been reported to present with myopericarditis; however, the definitive mechanism is unknown. Our patient was diagnosed with myopericarditis after a thorough investigation and diagnostic work-up. After discussing risks versus benefits, the patient was started on colchicine and ibuprofen, which saw a resolution in symptoms in two weeks. In conclusion, a wide differential should be made for patients who present with myopericarditis.
Conflict of Interest
The authors have no conflicts of interest to disclose.
Funding
No funding was sought in writing this case report.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
