Gastroenterology case report of mesalazine-induced cardiopulmonary hypersensitivity

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.

Systematic review: safety of mesalazine in ulcerative colitis

“…The development of pneumonia as an adverse event to mesalazine therapy has been documented in case reports. These span from interstitial pneumonitis, interstitial pneumonia, Wegener's granulomatosis and eosinophilic pneumonia . Development of bronchiolitis obliterans with organising pneumonia has also been reported, with improvement noted once the drug has been discontinued and patient has received corticosteroids …”

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

“…Most cases occurred between 1 month and 7 months after the initiation of the drug, with rare cases occurring 2 years later. 7 , 9 , 13 – 19 The clinicopathologic and radiologic features of these patients and our patient are summarized in Table 2 .…”

“… 12 Over the past two decades, several cases of mesalazine-induced pulmonary toxicity have been reported, particularly eosinophilic pneumonia. 7 , 9 , 13 – 19 The incidence of lung disease from mesalazine is unknown; however, reports from mesalazine-induced lung disease have increased, and the pathogenesis is still unknown. 8 Immune-mediated injury and direct cytotoxic effect are considered as causes of drug-induced lung injury.…”

“…Women were reported to be affected more often than men. 6 Among nine previously published case reports of mesalazine-induced eosinophilic pneumonia, there were three males 13 , 16 , 17 and six females 7 , 9 , 14 , 15 , 18 , 19 with a mean age of 34 years (ranging from 23 years to 50 years). Most cases occurred between 1 month and 7 months after the initiation of the drug, with rare cases occurring 2 years later.…”

Mesalazin-induced eosinophilic pneumonia in a 15-year-old boy with ulcerative colitis

“…После того, как препарат был отменен и началось лечение стероидами, легочные инфильтраты полностью разрешились [17]. Еще один случай демонстрирует развитие одышки у больного спустя 9 мес от начала приема орального месалазина, пациент полностью выздоровел после стероидной терапии и прекращения приема месалазина [18]. В 2017 г. опубликовано клиническое наблюдение за 22-летним мужчиной, страдающим язвенным колитом, в течение 9 мес получавшем месалазин.…”