Cardiovascular involvement in children with inflammatory bowel disease: the experience of an Italian tertiary centre

INTRODUCTION: Cardiovascular involvement in paediatric inflammatory bowel disease (PIBD) is rarely described; aetiology is either driven by medications or IBD itself. We report a case-series of PIBD patients with cardiovascular involvement in an Italian tertiary centre. Methods: We retrospectively reviewed the clinical records of 221 PIBD patients followed-up in our centre (01/2021 - 01/2024). We identified 3/221 (1.4%) patients with history of cardiovascular involvement for whom we collected demographic, clinical and treatment data. Results: Overall, 2/3 patients with Crohn’s disease (Paris classification A1aL3L4aB1G1 and A1aL3L4aB1pG1) were diagnosed with pericarditis, 1/3 with ulcerative colitis (Paris classification E1S0) developed myopericarditis. All patients were male; median age at carditis onset was 12.5 years (range 9-15) with a median time between IBD onset and carditis of 26 months (range 1-72). All patients presented with chest pain worsened by clinostatism, only one had concomitant fever. Concerning pericarditis patients, at carditis onset one had mildly active disease while on oral mesalazine and the second was on no medical treatment after having received ileocolic resection 2 months earlier. The myopericarditis patient was in remission on rectal mesalazine, having received COVID-19 mRNA vaccine 3 days earlier. Pericarditis were treated with non-steroidal anti-inflammatory drugs while myopericarditis with oral corticosteroids. All patients recovered fully without apparent sequelae. Conclusion: Cardiovascular involvement in PIBD is infrequent but remains a potential complication that warrants attention. In our experience, pericarditis appeared to be related to IBD itself, whereas myopericarditis remained of uncertain aetiology. Clinicians should maintain a low threshold for diagnosis in case of suggestive symptomatology to allow a prompt management.