Ulcerative colitis and acute perimyocarditis

A 32yearold man with 15 years of intermittent bloody diarrhoea was diagnosed with ulcerative proctosigmoiditis. He was commenced on mesalazine 4.8 g four times per day with prednisone enemas. After 13 days of treatment, he presented with ten bloody stools per day and sharp, pleuritic chest pain. The patient was febrile (38.1°C) and clinically hypovolemic, with blood pressure 110/70 mmHg, heart rate 107 beats per minute, and peripheral oxygen saturation on room air 97%. A 12lead electrocardiogram (ECG) demonstrated sinus tachycardia with PR segment depression and concave ST segment elevation without dynamic changes (Box 1). High sensitivity troponin T (on admission, 122 ng/L; serial [2 h], 109 ng/L; reference interval [RI], ≤ 14 ng/L), erythrocyte sedimentation rate (22 mm/h; RI, 0– 10 mm/h), Creactive protein (23 mg/L; RI, ≤ 4.9 mg/L) and faecal calprotectin (70 μg/g; RI, ≤ 50 μg/g) were elevated. Blood cultures and respiratory viral testing, including for severe acute respiratory syndrome coronavirus 2 (SARSCoV2), were negative. Perimyocarditis was suspected and colchicine 500 μg twice daily was commenced.