Mesalazine-induced Hypersensitivity Pneumonitis

Abstract

A 57-year-old woman with Crohn's disease (ulcerative proctitis) treated with mesalazine (5-ASA) developed worsening respiratory distress and cough. The lack of response to antibiotics and the results of bronchoalveolar lavage led to the diagnosis of mesalazine-related hypersensitivity pneumonitis, an infrequent entity. Symptoms improved after discontinuation of mesalazine and the administration of corticosteroid therapy. The authors discuss the diagnosis and management of this rare condition.

Recurrent bilateral lung infiltrates in a patient with ulcerative colitis

“…Although mesalazine is usually well tolerated, associated toxicity has been rarely described with eosinophilic, cryptogenic organised or nonspecific interstitial pneumonia as the more typical patterns of respiratory involvement [ 2 , 3 ]. The duration of treatment with mesalazine before the onset of symptoms varies between 1 month and several years (up to 8 years) [ 4 , 5 ].…”

Mesalazine-Induced Diffuse Lung Injury in a Patient Without Respiratory Signs and Symptoms

“…esalazine is a drug that treats ulcerative colitis (UC) and Crohn's disease (1). Very rarely, this drug is known to cause lung injury (2)(3)(4)(5)(6)(7)(8)(9)(10)(11). The mechanism is assumed to be direct drug-induced damage to type II alveolar epithelial cells and vascular endothelial cells, and drug-induced activation of immune system cells (12).…”

“…The mechanism is assumed to be direct drug-induced damage to type II alveolar epithelial cells and vascular endothelial cells, and drug-induced activation of immune system cells (12). With the exception of some patients with central bronchiectasis and bronchiolitis (2,3), most of the patients had lung involvement with diffuse lung opacities (4)(5)(6)(7)(8)(9)(10)(11). For this rare adverse event, it is necessary to differentiate between pulmonary infections of va-rious micro-pathogens or pulmonary complications due to UC itself (4)(5)(6)(7)(8)(9)(10)(11).…”

“…With the exception of some patients with central bronchiectasis and bronchiolitis (2,3), most of the patients had lung involvement with diffuse lung opacities (4)(5)(6)(7)(8)(9)(10)(11). For this rare adverse event, it is necessary to differentiate between pulmonary infections of va-rious micro-pathogens or pulmonary complications due to UC itself (4)(5)(6)(7)(8)(9)(10)(11). In critical cases with a typical clinical-radiological and temporal presentation, the initiation of therapy should not be delayed by an elaborate diagnostic approach.…”

“…Imaging findings, pathological histopathology, drug administration status and disease control status of UC can be useful in the differential diagnosis of other diseases, but are not direct diagnostic evidence (13). Some patients with this drug-induced lung injury were critically ill patients requiring supplemental oxygen and mechanical ventilation (8,10,11) and other patients had respiratory symptoms but did not require such treatment (6,9). Patients with severe respiratory failure may not tolerate bronchoscopic tissue sampling.…”