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Miscellaneous |

Pericarditis as a Complication of Acute Colitis: A Case Report FREE TO VIEW

Gilberto Franco, MD; Carlos Alves, MD; Pamela Bianchet, MD
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ICU, Hospital Jardim Cuiabá, Cuiabá, Mato Grosso, Brazil


Chest. 2015;148(4_MeetingAbstracts):658A. doi:10.1378/chest.2262671
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Abstract

SESSION TITLE: Miscellaneous Global Case Reports

SESSION TYPE: Global Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: Pericarditis has been reported as an extra intestinal manifestation of some inflammatory bowel disease (IBD) including ulcerative colitis, Crohn's disease, intestinal tuberculosis, as well as in nonspecific IBD. Those cases are underreported. We, therefore, describe a case report of pericarditis in conjunction with nonspecific IBD.

CASE PRESENTATION: A 46-year-old previously healthy Brazilian woman complained of sudden onset of watery, purulent but non-bloody diarrhea associated with crampy abdominal pain, along with blunt chest pain. EKG showed diffused repolarization alteration and normal troponin t levels. Both echocardiogram (ECO) and cardiac resonance (CR) showed small pericardium effusion. ECO showed 63% ejection fraction and no evidence of wall motion abnormalities. Cardiac catheterization revealed normal coronary arteries. Colonoscopy showed macroscopically congested and eroded mucosa from the terminal ileum to the descending colon, with petechiae indicative of colitis. Microscopic examination of obtained biopsies revealed acute mucosal inflammation with superficial ulceration, without both granulomas and ischemia. Both ASCA and p-ANCA neutrophils exams were normal. The patient was treated with indomethacin 50mg bid, and supportive care. Chest pain improved gradually, and the patient was discharged asymptomatic five days after admission.

DISCUSSION: Cardiac complications of inflammatory bowel disease are rare; yet cases of pericarditis, myocarditis, and myopericarditis have been reported. Pericarditis is the most commonly reported complication. In general, viral and idiopathic cases of pericarditis have good prognosis. In our patient, the diagnosis of pericarditis was established on the bases of clinical features, electrocardiographic changes, ECO and CR alterations in the absence of coronary artery abnormalities by cardiac catheterization.

CONCLUSIONS: Pericarditis may be a challenging diagnosis, especially when considered as an extra intestinal manifestation of both specific and nonspecific colitis.

Reference #1: Myopericarditis as a complication of nonspecific colitis. Alkhateeb H, Said S, Cooper CJ, Elhanafi S, Teleb M, Saifuddin F, Mukherjee D, Abbas A, Davis HE 2nd. Am J Case Rep. 2014 Feb 21;15:82-4. doi: 10.12659/AJCR.890006. eCollection 2014.

Reference #2: Pericarditis in exacerbation of ulcerative colitis. Virovic Jukic L, Duvnjak M, Barsic N, Lerotic I, Tomasic V, Pavic T. Acta Gastroenterol Belg. 2006 Oct-Dec;69(4):390-2.

Reference #3: Acute pericarditis and ulcerative colitis. Rodríguez Blanco VM, Barriales Alvarez V, Cortina Llosa A. An Med Interna. 1997 Nov;14(11):598-9.

DISCLOSURE: The following authors have nothing to disclose: Gilberto Franco, Carlos Alves, Pamela Bianchet

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