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Sato T, Tagawa M, Izumi I, Kiwamoto T, Sumazaki R. Mesalazine-induced lung injury in a child; the value of bronchoscopy. Pediatr Int 2021; 63:1402-1404. [PMID: 34390090 DOI: 10.1111/ped.14640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/12/2021] [Accepted: 02/01/2021] [Indexed: 01/20/2023]
Affiliation(s)
- Takuro Sato
- Department of General Pediatrics, Ibaraki Children's Hospital, Mito, Japan
| | - Manabu Tagawa
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Isho Izumi
- Department of General Pediatrics, Ibaraki Children's Hospital, Mito, Japan
| | - Takumi Kiwamoto
- Department of Pulmonary Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Ryo Sumazaki
- Department of General Pediatrics, Ibaraki Children's Hospital, Mito, Japan
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2
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Cernomaz AT, Bordeianu G, Terinte C, Gavrilescu CM. Nonasthmatic eosinophilic bronchitis in an ulcerative colitis patient – a putative adverse reaction to mesalazine: A case report and review of literature. World J Clin Cases 2020; 8:4162-4168. [PMID: 33024774 PMCID: PMC7520771 DOI: 10.12998/wjcc.v8.i18.4162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/06/2020] [Accepted: 08/29/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Lung and airway involvement in inflammatory bowel disease are increasingly frequently reported either as an extraintestinal manifestation or as an adverse effect of therapy.
CASE SUMMARY We report a case of a patient with ulcerative colitis controlled under mesalazine treatment who presented with chronic cough and hemoptysis. Chest computed tomography and bronchoscopy findings supported tracheal involvement in ulcerative colitis; pathology examination demonstrated an unusual eosinophil-rich inflammatory pattern, and together with clinical data, a nonasthmatic eosinophilic bronchitis diagnosis was formulated. Full recovery was observed within days of mesalazine discontinuation.
CONCLUSION Mesalazine-induced eosinophilic respiratory disorders have been previously reported, generally involving the lung parenchyma. To the best of our knowledge, this is the first report of mesalamine-induced eosinophilic involvement in the upper airway.
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Affiliation(s)
- Andrei Tudor Cernomaz
- Department of Internal Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iasi 700115, Romania
| | - Gabriela Bordeianu
- Department of Biochemistry, Grigore T. Popa University of Medicine and Pharmacy, Iasi 700115, Romania
| | - Cristina Terinte
- Department of Pathology, Regional Oncology Institute, Iasi 700483, Romania
| | - Cristina Maria Gavrilescu
- Department of Internal Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iasi 700115, Romania
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Ferrusquía J, Pérez-Martínez I, Gómez de la Torre R, Fernández-Almira ML, de Francisco R, Rodrigo L, Riestra S. Gastroenterology case report of mesalazine-induced cardiopulmonary hypersensitivity. World J Gastroenterol 2015; 21:4069-4077. [PMID: 25852295 PMCID: PMC4385557 DOI: 10.3748/wjg.v21.i13.4069] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 11/27/2014] [Accepted: 01/21/2015] [Indexed: 02/06/2023] Open
Abstract
Mesalazine is a 5-aminosalicylic acid derivative that has been widely used to treat patients with inflammatory bowel disease. Accumulating evidence indicates that mesalazine has a very low rate of adverse drug reactions and is well tolerated by patients. However, a few cases of pulmonary and cardiac disease related to mesalazine have been reported in the past, though infrequently, preventing clinicians from diagnosing the conditions early. We describe the case of a 32-year-old man with ulcerative colitis who was admitted with a two-month history of persistent fever following mesalazine treatment initiated 14 mo earlier. At the time of admission, mesalazine dose was increased from 1.5 to 3.0 g/d, and antibiotic therapy was started with no improvement. Three weeks after admission, the patient developed dyspnea, non-productive cough, and chest pain. Severe eosinophilia was detected in laboratory tests, and a computed tomography scan revealed interstitial infiltrates in both lungs, as well as a large pericardial effusion. The bronchoalveolar lavage reported a CD4/CD8 ratio of 0.5, and an increased eosinophil count. Transbronchial biopsy examination showed a severe eosinophilic infiltrate of the lung tissue. Mesalazine-induced cardiopulmonary hypersensitivity was suspected after excluding other possible etiologies. Consequently, mesalazine treatment was suspended, and corticosteroid therapy was initiated, resulting in resolution of symptoms and radiologic abnormalities. We conclude that mesalazine-induced pulmonary and cardiac hypersensitivity should always be considered in the differential diagnosis of unexplained cardiopulmonary symptoms and radiographic abnormalities in patients with inflammatory bowel disease.
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Kang SM, Jang YR, Yoon HH, Kim S, Kim EY, Ha SY, Park JW. A Case of Balsalazide-Induced Limited Form of Granulomatosis with Polyangiitis with Bronchiolitis Obliterans Organizing Pneumonia-like Variant in Ulcerative Colitis. Tuberc Respir Dis (Seoul) 2012; 72:323-7. [PMID: 23227073 PMCID: PMC3510283 DOI: 10.4046/trd.2012.72.3.323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 01/27/2012] [Accepted: 01/12/2012] [Indexed: 11/24/2022] Open
Abstract
5-Aminosalicylate agents are the main therapeutic agents for ulcerative colitis. Balsalazide is a prodrug of 5-aminosalicylate and has fewer side effects than the other 5-aminosalicylate agents. Pulmonary complications resembling granulomatosis with polyangiitis in ulcerative colitis are extremely rare. Here, we report a patient with ulcerative colitis on balsalazide presenting respiratory symptoms and multiple pulmonary nodules from a chest radiography that was pathologically diagnosed with a limited form of granulomatosis with polyangiitis with bronchiolitis obliterans organizing pneumonia-like variant. To our knowledge, this is the first report of a balsalazide-induced limited form of granulomatosis with polyangiitis with bronchiolitis obliterans organizing pneumonia-like variant.
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Affiliation(s)
- Shin Myung Kang
- Department of Pulmonary and Critical Care Medicine, Gachon University Gil Hospital, Incheon, Korea
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5
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[Interstitial pneumonia related to mesalamine]. ACTA ACUST UNITED AC 2010; 34:224-6. [PMID: 20299168 DOI: 10.1016/j.gcb.2009.08.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Revised: 04/08/2009] [Accepted: 08/20/2009] [Indexed: 12/21/2022]
Abstract
We report the case of a 57-year-old woman with ulcerative colitis since eight years who developed a diffuse interstitial pneumonia linked to mesalazine (oral and enemas). The adverse drug-related effect to mesalazine was strongly suggested regarding improvement upon discontinuation and relapse after reinstitution of mesalazine. To date, after 8 years, the patient has not any respiratory symptom which is another argument for the adverse drug-related effect to mesalazine.
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6
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Cilloniz R, Chesrown SE, Gonzalez-Peralta RP. Asymptomatic presentation of mesalamine-induced lung injury in an adolescent with Crohn disease. BMJ Case Rep 2009; 2009:bcr09.2008.0908. [PMID: 21686567 DOI: 10.1136/bcr.09.2008.0908] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The present report describes the case of a 14-year-old boy receiving mesalamine for Crohn disease who was discovered to have incidental pulmonary infiltrates on chest radiograph and CT scan shortly after increasing the dose of this medication. Despite the significant radiographic abnormalities, he had no respiratory symptoms. He had normal oxygenation and normal pulmonary function tests including spirometry, lung volumes and diffusion capacity. Transbronchial biopsies showed patchy interstitial fibrosis with ill-defined non-necrotising granulomas and lymphoid aggregates. Pulmonary infiltrates resolved within 6 weeks of discontinuation of mesalamine and the addition of low-dose daily corticosteroids. This case likely represents an asymptomatic "early stage" of mesalamine-induced lung injury preceding the onset of symptoms. Alternatively, mesalamine may induce asymptomatic lung injury more commonly than is presently suspected. To the best of our knowledge this is the first time this complication has been reported without respiratory symptoms.
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Affiliation(s)
- Rafael Cilloniz
- University of Florida, Pediatrics, 1600 SW Archer Rd, PO Box 100296, Gainesville, Florida, 32610, USA
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7
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Price LC, Poullis A, Grubnic S, Kang JY, Rayner CFJ. Mesalazine-induced bronchiectasis and eosinophilia in a patient with ulcerative colitis: a case report. J R Soc Med 2007. [PMID: 17339311 DOI: 10.1258/jrsm.100.3.151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- L C Price
- Department of Respiratory Medicine, St George's Hospital, London, UK
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8
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Price LC, Poullis A, Grubnic S, Kang JY, Rayner CFJ. Mesalazine-induced bronchiectasis and eosinophilia in a patient with ulcerative colitis: a case report. J R Soc Med 2007; 100:151-2. [PMID: 17339311 PMCID: PMC1809164 DOI: 10.1177/014107680710000314] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- L C Price
- Department of Respiratory Medicine, St George's Hospital, London, UK
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10
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Foster RA, Zander DS, Mergo PJ, Valentine JF. Mesalamine-related lung disease: clinical, radiographic, and pathologic manifestations. Inflamm Bowel Dis 2003; 9:308-15. [PMID: 14555914 DOI: 10.1097/00054725-200309000-00004] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Lung injury related to mesalamine (5-aminosalicylic acid) has rarely been reported in patients with inflammatory bowel diseases. Patients present with progressive respiratory symptoms and radiographic abnormalities whose genesis may occur from days to years after initiation of therapy. Although pathologic features overlap with other pulmonary disorders, findings of chronic interstitial pneumonia and poorly formed nonnecrotizing granulomas should prompt consideration of mesalamine-related lung disease in a patient receiving this medication. The authors describe the clinical, radiographic, and pathologic manifestations of mesalamine-related lung disease in three patients and review the literature related to this topic.
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Affiliation(s)
- Runi A Foster
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida 32610, USA.
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Abstract
Extraintestinal manifestations of both Crohn's disease and ulcerative colitis (UC) have been well described, although pulmonary findings are often overlooked. We summarize the experience of more than 400 cases of pulmonary manifestations of inflammatory bowel disease (IBD). These manifestations will be categorized by disease mechanism into drug-induced disease, anatomic disease, over-lap syndromes, autoimmune disease, physiologic consequences of IBD, pulmonary function test abnormalities, and nonspecific lung disease. We intend to provide the clinician with a practical working update on the spectrum of pulmonary dysfunction associated with IBD.
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Affiliation(s)
- Ian Storch
- Department of Medicine, North Shore-Long Island Jewish Health Care System, Manhasset, New York, USA.
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Sviri S, Gafanovich I, Kramer MR, Tsvang E, Ben-Chetrit E. Mesalamine-induced hypersensitivity pneumonitis. A case report and review of the literature. J Clin Gastroenterol 1997; 24:34-6. [PMID: 9013348 DOI: 10.1097/00004836-199701000-00007] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A 49-year-old man with Crohn's disease treated with prednisone and mesalamine (5-ASA) developed worsening respiratory distress and fever. Symptoms improved after discontinuation of mesalamine. A rechallenge 3 months later caused similar pulmonary symptoms, confirming the association between the drug and the respiratory system. Mesalamine may cause hypersensitivity pneumonitis in patients with Crohn's disease.
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Affiliation(s)
- S Sviri
- Division of Medicine, Hadassah University Hospital, Jerusalem, Israel
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