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Plasma N-terminal pro-B-type natriuretic peptide (BNP) in mesalazine-induced myopericarditis
  1. Theodoros Paschalis1,
  2. Myrella Paschali2,
  3. Amit K J Mandal3 and
  4. Constantinos G Missouris3,4
  1. 1 University of Cambridge School of Clinical Medicine, Cambridge, Cambridgeshire, UK
  2. 2 Medical Faculty, Heinrich Heine University, Dusseldorf, Germany
  3. 3 Cardiology and Medicine, Frimley Health NHS Foundation Trust, Slough, Berkshire, UK
  4. 4 Medical School, University of Cyprus, Nicosia, Cyprus
  1. Correspondence to Constantinos G Missouris, dinos.missouris{at}


Mesalazine (5-aminosalicylic acid)-based products are a widely used treatment for inflammatory bowel disease in children and adults. Associated myopericarditis is an uncommon but recorded phenomenon related to drug hypersensitivity. Unless recognised, this important complication may culminate in the development of dilated cardiomyopathy and severe heart failure. We report the case of a boy with Crohn’s disease who developed myopericarditis 14 days after starting treatment with mesalazine. Discontinuation of the drug rapidly led to normalisation of left ventricular structure and function, and a parallel improvement in the levels of plasma N-terminal pro-B-type natriuretic peptide and other markers of myocardial damage. Clinicians should be aware of this potentially life-threatening adverse effect of mesalazine therapy, which is quickly and fully reversible on cessation of the agent.

  • heart failure
  • cardiovascular system
  • gastrointestinal system

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  • Contributors TP conceptualised and designed the study, drafted the initial manuscript, and approved the final manuscript as submitted. MP performed the literature search, drafted the manuscript and approved the final manuscript as submitted. AKJM analysed the data, provided clinical input, reviewed and revised the manuscript, and approved the final manuscript as submitted. CGM was an expert clinical consultant, and analysed the data, critically reviewed the manuscript and approved the final manuscript as submitted. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.