Mesalazine-induced lung injury with severe respiratory failure successfully treated with steroids and non-invasive positive pressure ventilation

Abstract

Drug-induced lung injury (DLI) has become more common because of the increasing number of therapeutic agents in use. Mesalazine, also known as 5-aminosalicylic acid (5-ASA), is one of the key drugs for the treatment of ulcerative colitis (UC). Although mesalazine-induced lung injury has been previously reported, few cases have included severe respiratory failure. In this report, we present a case of mesalazine-induced lung injury with severe respiratory failure, which was improved by discontinuation of mesalazine and introduction of corticosteroid therapy and ventilation support with non-invasive positive pressure ventilation (NPPV). We also review the previous literature on mesalazine-induced lung injury.

Lung Involvement in Inflammatory Bowel Diseases: Shared Pathways and Unwanted Connections

“…Almost all cases presented with mild or no respiratory failure and were successfully treated only by discontinuation of the drug or administration of low-dose corticosteroids. Only two cases of severe respiratory failure due to mesalazine use have been described in the literature [113,114]. The time from drug exposure to lung injury is unclear from the literature (from days to months), so further studies are needed to better understand the relationship between time from drug exposure and lung injury.…”

Fulminant organizing pneumonia in a patient with ulcerative colitis on mesalamine and infliximab: striving to identify the cause!

“… 3 There are less than 20 case reports of histologically proven mesalamine-related OP in the literature, few of which were severe enough to require noninvasive positive airway pressure support. 3 , 5 - 7 …”

“…(3) Existem menos de 20 casos comprovados histologicamente de PO secundária à mesalazina descritos na literatura, poucos dos quais suficientemente graves para necessitar de suporte ventilatório não invasivo com pressão positiva na via aérea. (3,(5)(6)(7) Globalmente, o presente caso exemplifica o desafio diagnóstico que constitui um cenário de DPI rapidamente progressiva em doentes com CU sob terapêutica imunomoduladora. A suspeição precoce para a possibilidade de doença pulmonar induzida por fármacos nestes doentes, com exclusão atempada de outras etiologias, é crucial.…”

Mesalazine induced interstitial pneumonitis in the COVID era

“…Mesalazine-induced interstitial pneumonitis is a reversible adverse effect that can be observed in patients treated with both oral and topical formulation of the drug (2,3) following a variable time period (few days-40 months). Complete clinical and radiological resolution is usually seen within a few days or weeks after starting steroids, but may be fatal in some cases (4). There are few reported cases in the literature and its real incidence is unknown.…”