Balsalazide induced myocarditis in patient with ulcerative colitis: a case report

Myocarditis induced by 5-aminosalicylic acid (ASA) is a rare and idiosyncratic adverse event requiring discontinuation of the drug. There have been very few cases of balsalazide induced myocarditis. Balsalazide is known to cause less complications compared to mesalamine due to its lower serum concentration. However, in the case of idiosyncratic adverse effects, clinicians should be aware that all 5-ASA drug have the potential to cause myocarditis in patients with ulcerative colitis (UC). We report a case of balsalazide induced myocarditis in a 26-year-old female patient with UC. She was treated UC with balsalazide and added topical mesalamine one month ago. Her myocarditis was improved by discontinuation of basalazide and topical mesalamine. We considered a recently added topical mesalamine as a cause of myocarditis. Although basalazide is 5-ASA, it was carefully re-introduction because it was previously well tolerable. Finally, balsalazide induced myocarditis was confirmed by recurrence of myocarditis.