A case of ulcerative colitis complicated with bronchiolitis obliterans organizing pneumonia (BOOP) and air leak syndrome

Pulmonary Pathology in Patients with Ulcerative Colitis Treated with Mesalazine—A Challenging and Complex Diagnostic Problem. Case Series and Literature Review

“…The results of histological examination of lung biopsy were available for 15 of 27 reviewed patients. Again, a diversity of patterns was present: eosinophilic pneumonia in two patients [15,22], organising stage of eosinophilic pneumonia with eosinophilic infiltrates in one patient [19], features of organising pneumonia in five patients [12,23,24,33], non-necrotising granulomas and scattered giant cells or giant cells alone in three patients [20,23,29] and interstitial fibrosis in two patients [18,23]. Only one of our patients had histopathological verification.…”

“…Patient 2 was using mesalazine rectal suppositories in addition to its oral preparation. In Patient [25,33]. Data on imaging studies (chest X-ray, CT scanning) were given for 25 of the reviewed patients.…”

“…Evidence in favour of the hypothetical toxic effect of mesalazine found in the reviewed papers included: 1) continuation of mesalazine administration, even in a reduced dose or even if GCs were added, caused worsening of clinical condition, hypoxaemia, opacities on chest X-ray and pulmonary function tests in some patients [14,20,22,25,30,32]; 2) lymphocytes stimulation test or basophile degranulation test for mesalazine yielded positive results in some patients [13,19,28]; 3) clinical and radiologic symptoms resolution was observed, usually within days or weeks from mesalazine discontinuation [13-15, 17-19, 27]; 4) reintroduction of mesalazine caused recurrence of symptoms within 2 days to 2 weeks in some patients [20,21,27]; and 5) in some patients with a history of previous toxicity of sulphasalazine, mesalazine caused the same effects [16]. In contrast, however, the following arguments question the contribution of mesalazine to the development of lung pathology: 1) successful reinstitution of mesalazine after an episode of its supposed lung toxicity in some patients [17,33]; 2) complete resolution of pulmonary problems without mesalazine cessation or any other action in some patients [29,34], even in patients with positive mesalazine lymphocyte stimulation tests [28]; and 3) occurrence of clinically, radiologically and histopathologically identical pulmonary disease in IBD patients not exposed to 5-aminosalicylic acid derivatives [24,29,34,[42][43][44][45][46][47][48]. Blood eosinophilia is considered to be a factor suggestive of drug-induced reaction.…”

Ulcerative colitis combined with acute interstitial lung disease and airway disease: A case report and literature review

“…In one case of UC, reported by Aydoğdu et al (1), the patient had complicated cryptogenic organizing pneumonia due to virus infection, and the clinical manifestations were acute respiratory distress and leak syndromes. The case reported in the present study manifested as an acute course of disease, but the diseases mentioned above could be excluded based on the patient history, clinical manifestations, imaging, pathology and other laboratory tests.…”

“…UC accompanied by pulmonary pathologies is rare in clinical settings; however, the early detection of pulmonary complications is critical for preventing the mortality of the patient (1). The rate of pulmonary complications caused by inflammatory bowel diseases is ~0.21% (2).…”