Infliximab-Associated Takotsubo Cardiomyopathy in a Patient With Ulcerative Colitis

Document Type

Conference Proceeding

Publication Date

10-1-2024

Publication Title

Am J Gastroenterol

Abstract

Introduction: Tumor Necrosis Factor-alpha (TNF-α) inhibitors have been associated with heart failure, myocarditis, and acute myocardial infarction (MI). Takotsubo (stress-induced) cardiomyopathy (TC) is characterized by transient regional systolic dysfunction and mimics MI but without evidence of obstructive coronary artery disease. While emotional stressors are commonly implicated in TC, there is increasing recognition of pharmacological triggers. Data, however, is scarce on the association of anti-TNF therapy with TC. Here, we present a case of a 53-year-old woman with ulcerative colitis admitted to our hospital with TC, thought to be related to infliximab. Case Description/Methods: A 53-year-old woman with a history of left sided ulcerative colitis for 2 years had recently undergone escalation of therapy for colitis due to breakthrough symptoms despite maximum mesalamine therapy. She was started on infliximab 5mg/kg and underwent standard induction doses at week 0,2,6 and received 1 maintenance dose which resulted in clinical remission. However, she presented to the emergency department 19 days after her fourth infusion with complaints of chest pain, dyspnea, and diaphoresis. On arrival, her vital signs and electrocardiogram were normal, but her highsensitivity troponin levels were elevated, peaking at 2180 ng/L. A computed tomography scan was negative for pulmonary embolism, while an echocardiogram revealed regional wall motion abnormalities concerning for TC. Subsequent cardiac catheterization demonstrated non-obstructive coronary artery disease and a diagnosis of TC was confirmed. Upon review of her clinical and medication history, the inpatient cardiology team felt infliximab was a possible culprit for her presentation, although a definitive relationship could not be established. After discharge, she followed up with her gastroenterologist, who discontinued infliximab and started her on vedolizumab therapy for her ulcerative colitis. Discussion: TNF-α inhibitors are widely used in the management of inflammatory bowel disease (IBD) but are seldom implicated in cardiovascular adverse events. In our case, the temporal relationship between the initiation of infliximab and the development of TC raises suspicion for a potential association. Although rare, it is important for clinicians to remain cognizant of potential cardiovascular adverse events in patients with IBD who are undergoing biologic therapy, especially if they have existing cardiac risk factors. Switching to a different drug class should be considered.

Volume

119

Issue

10

First Page

S2536

Find It @ Sladen

Share

COinS