Salazopyrin-Induced Eosinophilic Pneumonia

Berliner, S; Neeman, A; Shoenfeld, Y.; Eldar, Michael; Rousso, I.; Kadish, U; Pinkhas, J

doi:10.1159/000194205

Cited by 31 publications

(6 citation statements)

References 3 publications

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“…A total of 47 cases of pulmonary dysfunction with sulfasalazine and mesalamine have been documented in the literature (9–50). The most common disease entity is eosinophilic pneumonia (9–16), which is defined as an infiltration of the lungs with eosinophils with or without excessive eosinophils in the peripheral blood (51).…”

Section: Drug‐induced Diseasementioning

confidence: 99%

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Pulmonary Manifestations of Inflammatory Bowel Disease

Storch

Sachar²,

Katz

2003

Inflammatory Bowel Diseases

195

131

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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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Section: Drug‐induced Diseasementioning

confidence: 99%

“…Definitive diagnosis of drug reaction was diagnosed by rechallenge with the inciting agent and reoccurrence of symptoms in 100% of patients tested (12,14,16,22,24,25,28–30,35,43). Symptoms resolved in most cases within a few days to weeks after withdrawal of the 5‐ASA product.…”

Section: Drug‐induced Diseasementioning

confidence: 99%

Pulmonary Manifestations of Inflammatory Bowel Disease

Storch

Sachar²,

Katz

2003

Inflammatory Bowel Diseases

195

131

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“…Various side effects such as nausea, gastric discomfort, headache, anorexia, skin rashes, male infertility and pulmonary syndromes have been described in association with SASP treatment [2][3][4][5]. SASP is metabolized by intestinal bacteria to SP and 5-ASA.…”

Section: Discussionmentioning

confidence: 99%

“…Most of the pulmonary adverse effects caused by treatment with SASP have been attributed to SP, i.e. the carrier component of SASP, and not to the 5-ASA component [2][3][4][5]. However, few cases of mesalazine-induced pulmonary involvement have been described [6][7][8][9][10][11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Mesalazine-Induced Eosinophilic Pneumonia

Tanigawa¹,

Sugiyama²,

Matsuyama³

et al. 1999

Respiration

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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 occured 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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“…The triad of breathlessness, cough and fever was present in 21 of the 50 cases (42%). Rash was commented on in 4 cases [16,27,36,37]. One of these patients developed an initial rash and underwent desensitization with the drug only to subsequently develop a pneumonitis on re-exposure [36].…”

Section: Symptoms and Signsmentioning

confidence: 99%

Sulphasalazine and lung toxicity

Parry¹,

Barbatzas²,

Peel³

et al. 2002

Eur Respir J

135

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Sulphasalazine prescribing is on the increase. Pulmonary toxicity and blood dyscrasias are rare side-effects. Numerous case reports have been published implicating sulphasalazine in pulmonary toxicity. The authors searched the literature for cases of sulphasalazine induced lung toxicity and the 50 cases identified are discussed here.All published case reports/letters referring to sulphasalazine and lung toxicity were studied. The search terms "sulphasalazine" and "sulfasalazine" were combined with the terms "lung", "pulmonary disease", "pneumonitis" and "pleuritis" using Medline and PubMed databases.Typical presentation of sulphasalazine-induced lung disease was with new onset dyspnoea and infiltrates on chest radiography. Common symptoms were cough and fever. Crepitations on auscultation and peripheral eosinophilia were noted in half of the cases. Sputum production, allergy history, rash, chest pain and weight loss were inconsistent findings. Pulmonary pathology was variable, the commonest being eosinophilic pneumonia with peripheral eosinophilia and interstitial inflammation with or without fibrosis. Fatal reports were infrequent. Most patients were managed by drug withdrawal with 40% prescribed corticosteroids.In conclusion, sulphasalazine lung disease should be distinguished from interstitial lung disease due to underlying primary disease. Despite the increase in sulphasalazine prescribing, pulmonary toxicity remains rare. The majority of patients with suspected sulphasalazine-induced lung disease improved within weeks of drug withdrawal and the need for corticosteroids is debatable. Sulphasalazine has been used worldwide since the 19409s when it was first prescribed for ulcerative colitis. Its use in the management of inflammatory bowel disease (IBD) is declining with the availability of newer nonsulphur containing aminosalicylates. Conversely, its use as a disease-modifying antirheumatoid drug (DMARD) in the treatment of rheumatoid arthritis is well known [1], its pattern of prescribing by rheumatologists is changing with the development of combination therapies and earlier prescribing of DMARD9s in the course of the disease [2,3]. Overall prescribing of sulphasalazine is on the increase. Information provided from the statistics division 1E of the Department of Health shows that in the decade 1980-1990 there were 4.3 million prescriptions for sulphasalazine with 652 million tablets prescribed. In the last decade to 1998 there were 4.6 million prescriptions with 698 million tablets prescribed.Sulphasalazine has clinically important side-effects in up to one-fifth of patients but these are mostly nausea and vomiting, skin rashes, arthralgia, fever and hepatic dysfunction. More serious side-effects include pulmonary toxicity and blood dyscrasias. Early case reports of adverse effects were published in the 19609s [4] and knowledge of adverse pulmonary effects is not new [5][6][7]. Numerous case reports have been published in the last 30 yrs implicating sulphasalazine in pulmonary toxicity. The presen...

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Salazopyrin-Induced Eosinophilic Pneumonia

Cited by 31 publications

References 3 publications

Pulmonary Manifestations of Inflammatory Bowel Disease

Pulmonary Manifestations of Inflammatory Bowel Disease

Mesalazine-Induced Eosinophilic Pneumonia

Sulphasalazine and lung toxicity

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