Sulfasalazine Pulmonary Toxicity in Ulcerative Colitis Mimicking Clinical Features of Wegener's Granulomatosis

Salerno, Stephen; Ormseth, Eric; Roth, Bernard; Meyer, Cristopher A.; Christensen, Erik Damgaard; Dillard, Thomas A.

doi:10.1378/chest.110.2.556

Cited by 52 publications

(26 citation statements)

References 11 publications

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“…Tracheal involvement in Crohn's disease is even more unusual and consists of mucosal inflammation (10)(11)(12). Drug therapy is another complicating factor, since sulfasalazine used in the treatment of Crohn's disease can also cause reactions in the lung (13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

Bronchial hyperresponsiveness and analysis of induced sputum cells in Crohn's disease

Bártholo

Zaltman

Elia

et al. 2005

Braz J Med Biol Res

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With the aim of investigating the presence of latent inflammatory process in the lungs of patients with Crohn's disease, 15 patients with Crohn's disease were evaluated by spirometry, the methacholine challenge test, induced sputum, and skin tests for inhaled antigens. Serum IgE, erythrocyte sedimentation rate and hematocrit were also determined. The patients were compared with 20 healthy controls by the Mann-Whitney and Fisher exact tests. Their respiratory physical examination was normal. None had a personal or family history of clinical atopy. None had a previous history of pulmonary disease, smoking or toxic bronchopulmonary exposure. None had sinusitis, migraine, diabetes mellitus, or cardiac failure. Four (26.6%) of the patients with Crohn's disease had a positive methacholine challenge test whereas none of the 20 controls had a positive methacholine test (P = 0.026, Fisher exact test). Patients with Crohn's disease had a higher level of lymphocytes in induced sputum than controls (mean 14.59%, range 3.2-50 vs 5.46%, 0-26.92%, respectively; P = 0.011, Mann-Whitney test). Patients with Crohn's disease and a positive methacholine challenge test had an even higher percentage of lymphocytes in induced sputum compared with patients with Crohn's disease and a negative methacholine test (mean 24.88%, range 12.87-50 vs 10.48%, 3.2-21.69%; P = 0.047, Mann-Whitney test). The simultaneous findings of bronchopulmonary lymphocytosis and bronchial hyperresponsiveness in patients with Crohn's disease were not reported up to now. These results suggest that patients with Crohn's disease present a subclinical inflammatory process despite the absence of pulmonary symptoms.

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Section: Introductionmentioning

confidence: 99%

Bronchial hyperresponsiveness and analysis of induced sputum cells in Crohn's disease

Bártholo

Zaltman

Elia

et al. 2005

Braz J Med Biol Res

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“…Although our patient was using mesalazine, he had no signs of eosinophilic pneumonia (no skin eruptions and/or peripheric eosinophilia). Although Camus et al (7) reported BOOP as independent of sulfasalazine and 5-ASA, in several other reports, sulfasalazine therapy was found to be associated with BOOP (15,16). Drug-induced lymphocyte stimulation test (DLST) must be performed for the exact diagnosis of mesalazine-induced lung disease.…”

Section: Discussionmentioning

confidence: 99%

A case of ulcerative colitis complicated with bronchiolitis obliterans organizing pneumonia (BOOP) and air leak syndrome

Aydoğdu¹,

Gürsel²,

Özyılmaz³

et al. 2012

Turk J Gastroenterol

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“…High resolution computed tomography chest scans (HRCT) were performed in only 5 cases [8,23,49,51,52] showing typical infiltrates and ground glass opacities. Taking these cases sequentially the descriptions are as follows.…”

Section: Radiologymentioning

confidence: 99%

“…In one of these cases there was also an increase in lymphocytes [27]. In the remaining cases, the BAL was reported as abnormal in three with elevated lymphocytes ranging from 31%-43% but with no increase in eosinophils [22,23,54]. In one case there was an increase in neutrophils only [48].…”

Section: Histocytopathologymentioning

confidence: 99%

“…Sulphapyridine is believed to be responsible for most of the hypersensitivity reactions that occur, although the salicylate component may also be implicated since aspirin has been reported in association with eosinophilic pneumonia [63], and more recently, with pulmonary oedema [64]. Therefore, it is possible that there is cross-reactivity in the two aspirin sensitive susceptible patients in this study to the aminosalicylate component of sulphasalazine [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]. However, the component of the drug implicated is still not known and nor is the mechanism causing pulmonary toxicity.…”

Section: What Is It About Sulphasalazine That Can Cause Potential Advmentioning

confidence: 99%

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Sulphasalazine and lung toxicity

Parry¹,

Barbatzas²,

Peel³

et al. 2002

Eur Respir J

136

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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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Sulfasalazine Pulmonary Toxicity in Ulcerative Colitis Mimicking Clinical Features of Wegener's Granulomatosis

Cited by 52 publications

References 11 publications

Bronchial hyperresponsiveness and analysis of induced sputum cells in Crohn's disease

Bronchial hyperresponsiveness and analysis of induced sputum cells in Crohn's disease

A case of ulcerative colitis complicated with bronchiolitis obliterans organizing pneumonia (BOOP) and air leak syndrome

Sulphasalazine and lung toxicity

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