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      Mesalazine-induced eosinophilic pneumonia with bone marrow infiltration: a case report and literature review

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          Abstract

          Mesalazine-induced eosinophilic pneumonia has been rarely reported. We reported a case of mesalazine-induced eosinophilic pneumonia in a 56-year-old female who took mesalazine without a prescription for suspected ulcerative colitis. She had an elevated eosinophil count in peripheral blood and bronchoalveolar lavage fluid. Eosinophil infiltration was also noted in bone marrow aspirates. Chest radiograph and computed tomography demonstrated bilateral upper lung predominant infiltrates and spirometry showed a restrictive ventilatory defect with a reduced diffusion capacity. The patient recovered after cessation of mesalazine therapy. Mesalazine-induced lung damage should be considered in patients who develop unexplained respiratory symptoms while taking this agent.

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          Mesalazine-induced eosinophilic pneumonia.

          Ken Sugiyama, H Takagi, Y Iwanaga … (1998)
          A 35-year-old woman with a 6-month history of ulcerative colitis and treatment with oral mesalazine (5-aminosalicylic acid) developed dry cough, low-grade fever and bilaterally wandering pulmonary infiltrates. Improvement in clinical symptoms and radiological abnormalities occurred spontaneously after discontinuation of mesalazine. The transbronchial lung biopsy demonstrated the organizing stage of eosinophilic pneumonia. Drug lymphocyte stimulation test was positive for mesalazine and negative for sulfasalazine and sulfapyridine. The present case indicates that although mesalazine-induced eosinophilic pneumonia is an extremely rare entity, its possibility should be fully considered in patients developing unexplained respiratory symptoms while on mesalazine therapy.
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            Gastroenterology case report of mesalazine-induced cardiopulmonary hypersensitivity.

            José Ferrusquía, Isabel Pérez-Martínez, Ricardo Gómez de la Torre … (2015)
            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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              Can a drug-induced pulmonary hypersensitivity reaction be dose-dependent? A case with mesalamine.

              M G Cappellato, S. Stefani, P Sossai (2001)
              Mesalamine-induced pulmonary adverse drug reactions (ADRs) in the course of therapy for inflammatory bowel diseases are rare events, having been reported in only 21 cases. This response, resembling hypersensitivity pneumonitis, is considered to be immunologically mediated and thus dose-independent. We report the case of a 70-year-old woman with ulcerative colitis (UC) who developed biopsy-proven interstitial pulmonary disease (lymphocytic alveolitis and mild interstitial pulmonary fibrosis) three months after starting mesalamine therapy. The usual treatment in cases of ADR is cessation of the drug and initiation of corticosteroids. In this case, we continued the mesalamine therapy but halved the dose, and did not add corticosteroids. This approach led to a remission of the pulmonary manifestations without a resurgence of UC symptoms. Based on a review of the literature and our own observation, we challenge the concept that mesalamine-induced pulmonary injury is always due to a hypersensitivity reaction. The evidence suggests that in some cases pulmonary ADR is dose-related; in such instances the most accepted therapy is not necessarily the most appropriate one.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Ther Clin Risk Manag
                Journal ID (iso-abbrev): Ther Clin Risk Manag
                Journal ID (publisher-id): Therapeutics and Clinical Risk Management
                Title: Therapeutics and Clinical Risk Management
                Publisher: Dove Medical Press
                ISSN (Print): 1176-6336
                ISSN (Electronic): 1178-203X
                Publication date Collection: 2016
                Publication date (Electronic): 14 June 2016
                Volume: 12
                Pages: 975-981
                Affiliations
                [1 ]Division of Pulmonary and Critical Care Medicine, Department of Medicine, Fourth Medical College of Peking University, Beijing, People’s Republic of China
                [2 ]Department of Pathology, Jishuitan Hospital, Fourth Medical College of Peking University, Beijing, People’s Republic of China
                Author notes
                Correspondence: Yunjian Zhang, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Jishuitan Hospital, Fourth Medical College of Peking University, No 31, East Xinjiekou Street, Xicheng District, Beijing 100035, People’s Republic of China, Tel +86 136 9320 5037, Email zhangyjian@ 123456126.com
                Article
                Publisher ID: tcrm-12-975
                DOI: 10.2147/TCRM.S107012
                PMC ID: 4913963
                PubMed ID: 27366075
                SO-VID: f7a90d10-06d2-40c5-811f-077ccea2e17b
                Copyright © © 2016 Zhang et al. This work is published and licensed by Dove Medical Press Limited
                License:

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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                Subject: Case Report

                ScienceOpen disciplines: Medicine
                Keywords: mesalazine,pneumonia,eosinophil,colitis
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: mesalazine, pneumonia, eosinophil, colitis

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