Giant cell myocarditis, in a patient with Crohn's disease, treated with etanercept - a tumour necrosis factor-alpha antagonist

Cardiac disease in association with inflammatory bowel disease (IBD) is unc ommon. Reports include pericarditis, pericardial. effusion, myocarditis, my ocardial infarction, endocarditis and arrythmias. Myocardial inflammation r elated to IBD may be due to a drug hypersensitivity reaction or micronutrie nt deficiency, or may be secondary to the underlying IBD as an extraintesti nal manifestation. In this setting, myocarditis usually presents as congest ive heart failure and/or refractory arrhythmia. Prognosis varies among repo rted cases, including complete recovery, remission with recurrence and fata l disease. Treatment of myocarditis has included aminosalicylates and immun osuppressive medications. Recently, newer therapies for IBD have been devel oped, such as tumour necrosis factor-alpha (TNF-alpha) antagonists. The pre sent report describes a case of a 46-year-old man with clinical and endosco pic. evidence of moderately active colonic Crohn's disease who developed co ngestive heart failure due to giant cell myocarditis. Little clinical impro vement occurred with immunosuppressive therapy. Only after the addition of etanercept, a TNF-alpha p75 receptor antagonist, did complete clinical reso lution occur. These authors conclude that the use of TNF-alpha antagonists may be considered in the treatment of life-threatening extraintestinal mani festations of inflammatory bowel disease.