Mesalazine-Induced Multi-Organ Hypersensitivity

Abstract

Mesalazine therapy for ulcerative colitis has been reported to be effective and safe. Rare cases of mesalazine-induced renal, pancreatic, myo-pericardial, pleuro-pulmonary and haematological toxicity have been described separately. We report a case characterized by the simultaneous presence of fever, pericarditis, peripheral eosinophilia, eosinophilic pneumonia, anaemia and haematuria (together with proteinuria and leukocyturia) due to mesalazine treatment in a patient with ulcerative colitis. No clinical response had been obtained with corticosteroids and various antibacterial agents. When mesalazine treatment was suspended, all symptoms rapidly and totally disappeared, confirming the direct responsibility of this drug in causing these adverse events. We conclude that mesalazine can induce multi-organ hypersensitivity, which must always be considered as a possible adverse effect during treatment with this drug. To resolve this adverse event it is essential to discontinue mesalazine treatment.

5-Aminosalicylic Acid–Associated Myocarditis and Pericarditis: A Narrative Review

“…7,11,17,29,30,43,46,49 Cardiac echocardiography commonly showed the presence of pericardial effusion. [4][5][6][7]12,[15][16][17]20,23,24,26,27,29,37,42,44,52 If the pericardial effusion was sufficiently large, cardiac tamponade Table 1 This single copy is for your personal, non-commercial use only. For permission to reprint multiple copies or to order presentation-ready copies for distribution, contact CJHP at cjhpedit@cshp.ca Table 1 was sometimes noted.…”

“…6,25,33,37,42,44,53 Evidence of inflammation was frequently indicated by elevation of the erythrocyte sedimentation rate (Table 1) [13][14][15]27,30,32,36,38,40,43,46,[48][49][50][51] Elevated N-terminal pro-brain natriuretic peptide concentrations have also been found. 42,44 The presence or absence of any or all of the above symptoms and signs does not confirm the role of 5-ASA in the origin of the condition. The nonspecific findings may also be suggestive of other disease processes, such as ischemic myocardium or other inflammatory conditions of the heart or pericardium.…”

Successful Treatment of Ulcerative Colitis Associated with Hypereosinophilic Syndrome/Chronic Eosinophilic Leukemia

“…philia have been reported (15)(16)(17). When mesalazine treatment was suspended, eosinophilia rapidly disappeared, confirming the direct responsibility of this drug.…”

Eosinophilic Pneumonia Caused by Mesalazine: Case Report

“…Steroid tedavi iyileşmeyi hızlandırmak-tadır. [1][2][3][4][5][6] Mesalazin bronşiyal obliterans organize pnö-moni, nonspesifik interstisyel pnömoni, eozinofilik pnömoni gibi interstisyel akciğer hastalıklarına neden olabilmektedir. 3 Mesalazine bağlı akciğer hasarının mekanizması net olarak belli değildir.…”

“…Tanı; çoğu hastada BAL'da eozinofili saptanması ve transbronşiyal akciğer biyopsisinde eozinofilik pnömoniyi destekler bulgularla koyulmaktadır. [1][2][3][4][5][6] Patolojik tablo diğer pulmoner hastalıklarla örtüşebilmesine rağmen biyopsi örneklerinde kronik interstisyel pnömoni bulguları yanında zayıf forme nonnekrotizan granülomların varlığı bu ilacı kullanan hastalarda ilaca bağlı reaksiyonları düşündürmelidir. 5 İlaca bağlı akciğer hasarının bulguları, inflamatuar barsak hastalığına bağlı bulgulara çok benzediği için tanı koymak güç olabilmektedir.…”