{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T23:16:52Z","timestamp":1790983012399,"version":"4.1.0"},"reference-count":9,"publisher":"SMC Media","issue":"9","license":[{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Introduction: Mesalazine (5-aminosalicylic acid, 5-ASA) is the cornerstone treatment for mild-to-moderate ulcerative colitis. Although generally well tolerated, rare cases of drug-induced myocarditis have been reported. Distinguishing mesalazine-induced myocarditis from myocarditis related to inflammatory bowel disease is essential, as management differs substantially. Case description: A 43-year-old man with recently diagnosed ulcerative colitis presented with acute chest pain, fever and elevated cardiac biomarkers eight days after initiation of oral mesalazine (3 g\/day). Electrocardiography demonstrated diffuse ST-segment elevation, while echocardiography showed preserved left ventricular systolic function; coronary angiography excluded obstructive coronary artery disease. During hospitalisation, worsening gastrointestinal symptoms prompted escalation of mesalazine to 4.8 g\/day. Within 24 hours, the patient developed recurrent chest pain, fever and a marked increase in troponin, inflammatory markers and NT-proBNP. Viral and autoimmune investigations were negative. The close temporal relationship between symptom recurrence and dose escalation raised suspicion of mesalazine-induced myocarditis. Following discontinuation of mesalazine, rapid clinical and biochemical improvement was observed. A cardiac magnetic resonance imaging (MRI) performed on day 7 demonstrated myocardial oedema on T2-weighted sequences and non-ischaemic epicardial late gadolinium enhancement involving the apical and inferolateral segments. This fulfilled both T2-based and T1-based criteria of the 2018 modified Lake Louise criteria for acute myocarditis. At follow-up, the patient remained asymptomatic with complete recovery of ventricular function. Conclusion: Mesalazine-induced myocarditis is an uncommon but potentially serious adverse reaction that may mimic an extraintestinal manifestation of ulcerative colitis. Early recognition, careful assessment of drug exposure chronology and prompt withdrawal of mesalazine are crucial to prevent complications. Cardiac MRI plays a central role in confirming the diagnosis.<\/jats:p>","DOI":"10.12890\/2026_007204","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T12:50:03Z","timestamp":1787057403000},"source":"Crossref","is-referenced-by-count":1,"title":["Mesalazine-induced myocarditis following dose escalation in ulcerative colitis: a diagnostic challenge"],"prefix":"10.12890","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-0887-7511","authenticated-orcid":false,"given":"Alfonso","family":"Vidal L\u00f3pez","sequence":"first","affiliation":[{"name":"Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3104-3460","authenticated-orcid":false,"given":"Mar\u00eda Asunci\u00f3n","family":"Esteve Pastor","sequence":"first","affiliation":[{"name":"Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2940-9540","authenticated-orcid":false,"given":"Manuel","family":"Romero Mar\u00b4t\u00ednez","sequence":"first","affiliation":[{"name":"Gastroenterology Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7314-9779","authenticated-orcid":false,"given":"Lidia Mar\u00eda","family":"Carrillo Mora","sequence":"first","affiliation":[{"name":"Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8922-9877","authenticated-orcid":false,"given":"Joaqu\u00edn","family":"Salinas Garc\u00eda","sequence":"first","affiliation":[{"name":"Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen","family":"Agull\u00f3 L\u00f3pez","sequence":"first","affiliation":[{"name":"Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4993-9540","authenticated-orcid":false,"given":"Domingo Andr\u00e9s","family":"Pascual Figal","sequence":"first","affiliation":[{"name":"Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10397","published-online":{"date-parts":[[2026,8,18]]},"reference":[{"key":"10.12890\/2026_007204_ref1","doi-asserted-by":"crossref","unstructured":"Ammirati E, Moslehi JJ. Diagnosis and Treatment of Acute Myocarditis: A Review. JAMA. 2023;329(13):1098-1113. doi: 10.1001\/jama.2023.3371.","DOI":"10.1001\/jama.2023.3371"},{"key":"10.12890\/2026_007204_ref2","unstructured":"S\u00f8rensen HT, Fonager KM. Myocarditis and inflammatory bowel disease. A 16-year Danish nationwide cohort study. Dan Med Bull. 1997;44(4):442-4."},{"key":"10.12890\/2026_007204_ref3","doi-asserted-by":"crossref","unstructured":"Zhong Y, Li Z, Tao J, Yuan J, Fu Z. Drug-induced myocarditis: a real-world pharmacovigilance study using the FDA adverse event reporting system database. Expert Opin Drug Saf. 2026;25(1):123-130. doi: 10.1080\/14740338.2024.2416933.","DOI":"10.1080\/14740338.2024.2416933"},{"key":"10.12890\/2026_007204_ref4","doi-asserted-by":"crossref","unstructured":"Yan L, Zheng G. Drug-induced noninfectious myocarditis: a disproportionality analysis of the FAERS database. Expert Opin Drug Saf. 2025;24(3):345-353. doi: 10.1080\/14740338.2024.2423679.","DOI":"10.1080\/14740338.2024.2423679"},{"key":"10.12890\/2026_007204_ref5","doi-asserted-by":"crossref","unstructured":"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. doi: 10.12998\/wjcc.v10.i27.9750.","DOI":"10.12998\/wjcc.v10.i27.9750"},{"key":"10.12890\/2026_007204_ref6","doi-asserted-by":"crossref","unstructured":"Jhakri K, Al-Shudifat M, Sumra B, Kocherry C, Shamim H, Mohammed L. Mesalazine-Induced Myocarditis in Inflammatory Bowel Disease: A Systematic Review. Cureus. 2025;17(1):e78208. doi: 10.7759\/cureus.78208.","DOI":"10.7759\/cureus.78208"},{"key":"10.12890\/2026_007204_ref7","doi-asserted-by":"crossref","unstructured":"Puntmann VO, Zeiher AM, Nagel E. T1 and T2 mapping in myocarditis: seeing beyond the horizon of Lake Louise criteria and histopathology. Expert Rev Cardiovasc Ther. 2018;16(5):319-330. doi: 10.1080\/14779072.2018.1455499.","DOI":"10.1080\/14779072.2018.1455499"},{"key":"10.12890\/2026_007204_ref8","doi-asserted-by":"crossref","unstructured":"Schulz-Menger J, Collini V, Gr\u00f6schel J, Adler Y, Brucato A, Christian V, et al. 2025 ESC Guidelines for the management of myocarditis and pericarditis. Eur Heart J. 2025;46(40):3952-4041. doi: 10.1093\/eurheartj\/ehaf192.","DOI":"10.1093\/eurheartj\/ehaf192"},{"key":"10.12890\/2026_007204_ref9","doi-asserted-by":"crossref","unstructured":"Kyriakou M, Sakellaropoulos S, Constantinides T, Chatzantonis G, Avraamides P, Mitsis A. Myocarditis Related to the Use of Mesalazine. J Med Cases. 2023;14(7):237-243. doi: 10.14740\/jmc4104.","DOI":"10.14740\/jmc4104"}],"container-title":["European Journal of Case Reports in Internal Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/7204\/5921","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/7204\/5922","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/7204\/5922","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T09:28:08Z","timestamp":1788773288000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/view\/7204"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,18]]},"references-count":9,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.12890\/2026_007204","relation":{"has-manifestation":[{"id-type":"other","id":"1-172-7204-g5921","asserted-by":"subject"},{"id-type":"other","id":"1-172-7204-g5922","asserted-by":"subject"}],"is-part-of":[{"id-type":"other","id":"1-172","asserted-by":"subject"}]},"ISSN":["2284-2594"],"issn-type":[{"value":"2284-2594","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,18]]}}}