Broken Pancreas, Broken Heart

Fulminant (peri)myocarditis is a very infrequent EIM of IBD and oft en presents with sudden-onset severe congestive heart failure (4,5) . Clinical presentation is variable, but in the 2 – 4 weeks before presentation, patients oft en have fl u-like (e.g., fevers, arthalgias and malaise) and gastrointestinal symptoms. Laboratory fi ndings may include leukocytosis, eosinophilia, and elevated levels of ESR, cardiac troponin, and C-reactive protein. Myocarditis in these patients appears not to correlate with disease activity (2,3) . Early recognition of myo(peri)carditis is crucial and needs prompt treatment. Treatment of fulminant disease includes aggressive inotropic support possibly accompanied by the placement of an intra-aortic balloon pump and / or a ventricular assist device. In conclusion, this case report demonstrates the occurrence of lymphocytic myocarditis in a patient with previously undiagnosed Crohn ’ s disease. It cannot be fully excluded that the myocarditis found in this patient was unrelated to his Crohn ’ s disease. However, the reported occurrence of perimyocarditis in Crohn ’ s disease in the absence of another explanation for the myocarditis strongly suggests that the two are related. Awareness of the possibility of this rare and potentially life-threatening EIM of IBD is therefore important.