that is rare but crucial extra - intestinal complications during an exacerbation in patients with inflammatory bowel disease ( ibd)ulcerative colitis ( uc ) and crohn 's disease.1)2 ) cardiac complications occur particularly with uc,2 ) and few cases reported patients with various manifestation from fulminant myocarditis to mild form.3)4)5 ) control of the underlying diseases is often associated with resolution of myocarditis and prevention of recurrence.6 ) here we report a young female patient with fulminant myocarditis induced by uc treated with extracorporeal life support and infliximab . a 28-year - old woman was consulted for dyspnea and elevated cardiac biomarker ( ck - mb : 11.4 ng / ml , troponin i : 0.512 ng / ml ) from division of gastroenterology to cardiology . sinus tachycardia and non - specific st change was noted on her electrocardiography ( ecg ) and mild cardiomegaly and pulmonary congestion were noted on chest x - ray ( cxr ) . initial echocardiography showed dilated left ventricular ( lv ) dimension and decreased lv ejection fraction ( ef : 33% ) with preserved lv tissue velocities ( fig . 1 , supplementary movie 1 ) . we decided to apply extracorporeal membrane oxygenation ( ecmo ) for cardiac rest under impression of acute myocarditis because her coronary angiography showed normal coronary arteries ( fig . 2 ) in combination with global hypokinesia of lv . follow up echocardiography performed the following day ( fig . 3 , supplementary movie 2 ) showed much depressed lv systolic function ( ef : 10% ) and myocardial tissue velocities ( e ' : 10  3 cm / s , s ' : 6  2 cm / s ) . the 7th day after ecmo , massive hematochezia was occurred even with maintenance of corticosteroid ( methylprednisolone 33 mg ) . emergent sigmoidoscopy revealed diffuse maroon colored blood oozing from inflamed mucosa of transverse colon without discernable specific bleeding focus . increased lv wall thickness ( 8  13 mm ) and still depressed lv performance ( ef : 16% , e ' : 2 cm / s , s ' : 3 cm / s ) detected by echocardiography ( fig . 4 , supplementary movie 3 ) , wherein we added infliximab ( 215 mg ) infusion for uncontrolled inflammation . two days later , removal of ecmo was possible because she stabilized without further bleeding and echocardiography ( fig . 5 , supplementary movie 4 ) showed improved lv systolic function ( ef : 16  60% ) and myocardial tissue velocities ( e ' : 3  5 cm / s , s ' : 2  7 cm / s ) . 6 , supplementary movie 5 ) showed normal lv wall thickness ( 11  8 mm ) , ef ( 65% ) , and myocardial tissue velocities ( e ' : 12 cm / s , s ' : 10 cm / s ) . in addition , cardiac biomarkers ( ck - mb : 11.4  8.4  5.8  1.4 ng / ml , troponin i : 0.512  0.298  0.099  0.025 ng / ml ) , ecg , and cxr were all normalized ( fig . 7 ) . now she is stable and followed regularly on outpatient basis with maintenance of low dose steroid . uc is known to be a severe disease with many extra - colonic manifestations , such as skin involvement , rheumatic problems , and ocular complications.2 ) here we present a young female patient with uc and fatal cardiac complication that were not resolved with corticosteroids . in our patient , acute myocarditis was developed presenting dyspnea and elevated cardiac biomarkers during exacerbation of uc in the maintenance of corticosteroid . we rapidly decided to apply ecmo for cardiac rest even her lv ef was not severely depressed and also with preserved lv myocardial tissue velocities . as a result , our decision was not so impetuous because echocardiography performed the very next day revealed severely depressed lv ef and myocardial tissue velocities . unexpected abrupt hematochezia was occurred despite of maintenance of corticosteroid ( methylprednisolone 33 mg ) . not only sigmoidoscopy showed uncontrolled inflammation of transverse colon , echocardiography also revealed increased thickness of myocardium suggesting inflammatory phase of acute myocarditis.7 ) therefore we apply infliximab to control underlying bowel inflammation and acute management for uc . follow up echocardiography after infusion infliximab , result showed improved lv systolic function ( ef : 16  60% ) and myocardial tissue velocities ( e ' : 3  5 cm / s , s ' : 2  7 cm / s ) . infliximab is a chimeric monoclonal antibody against tumor necrosis factor alpha used to treat autoimmune diseases . although this agent has various adverse effects , some life - threatening , common to drugs in the class of immunosuppressants , patients with uc with treatment of infliximab was shown effective inflammation control.8 ) in conclusion , we report a young female patient with fulminant myocarditis associated with uc successfully treated with ecmo and infliximab . serial follow up of echocardiography and early decision of applying ecmo were particularly essential for management in our patient . control of underlying disease might be helpful to improve cardiac function , in case of acute myocarditis due to underlying ibd . initial echocardiography  dilated left ventricular ( lv ) dimension and decreased lv ejection fraction ( ejection fraction : 33% ) with preserved lv tissue velocities . second echocardiography  much depressed left ventricular systolic function ( ejection fraction : 10% ) and myocardial tissue velocities ( e ' : 10  3 cm / s , s ' : 6  2 cm / s ) . increased left ventricular ( lv ) wall thickness ( 8  13 mm ) and still depressed lv performance ( ejection fraction : 16% , e ' : 2 cm / s , s ' : 3 cm / s ) . 9th echocardiography improved left ventricular systolic function ( ejection fraction : 16  60% ) and myocardial tissue velocities ( e ' : 3  5 cm / s , s ' : 2  7 cm / s ) . normal left ventricular wall thickness ( 11  8 mm ) , ejection fraction ( 65% ) , and myocardial tissue velocities ( e ' : 12 cm / s , s ' : 10 cm / s ) .
we report a case of successfully treated acute fulminant myocarditis induced by ulcerative colitis with extracorporeal life support and infliximab . 
 myocarditis is a rare but crucial complication during an exacerbation of inflammatory bowel disease . in our case , we applied extracorporeal membrane oxygenation ( ecmo ) for cardiac rest under impression of acute myocarditis associated with ulcerative colitis , and added infliximab for uncontrolled inflammation by corticosteroid . as a result , our patient was completely recovered with successful weaning of ecmo .