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Case Reports
. 2018 Nov;97(48):e13242.
doi: 10.1097/MD.0000000000013242.

Mesalazine-related lung disease in a patient with ulcerative colitis: A case report

Po-Han Huang  1 , Chia-Jung Kuo  1   2 , Chang-Wei Lin  2   3 , Yu-Ming Cheng  4 , Han-Chung Hu  2   3 , Chun-Yen Lin  1   2 , Ming-Yao Su  1   2 , Cheng-Tang Chiu  1   2
Affiliations
Case Reports

Mesalazine-related lung disease in a patient with ulcerative colitis: A case report

Po-Han Huang et al. Medicine (Baltimore). 2018 Nov.

Abstract

Rationale: Mesalazine is widely used to treat inflammatory bowel disease (IBD). However, discriminating between pulmonary manifestations of IBD and drug-related lung disease remains a challenge. There were few case reports of mesalazine-related organizing pneumonia so far.

Patient concerns: A 75-year-old female was diagnosed with ulcerative colitis and took mesalazine over a period of 2 years and 8 months. She presented with progressive shortness of breath for 3 days and visited our emergency department. Chest radiography showed increased bilateral infiltrates. During hospitalization her clinical condition deteriorated, and she was transferred to our intensive care unit under noninvasive ventilator support.

Diagnosis: Computed tomography (CT) scan showed diffuse peribronchial and subpleural consolidations in bilateral lungs. Possible etiologies of interstitial lung disease were surveyed, including various infectious diseases and connective tissue diseases. Transbronchial lung biopsy showed characteristic features of organizing pneumonia.

Interventions: Under the consideration of mesalazine-related lung disease, mesalazine was discontinued early in disease course and steroid therapy was given.

Outcomes: The patient was discharged from hospital with improved clinical symptoms and radiographic images.

Lessons: Although this patient suffered a life-threatening adverse event, prompt diagnosis with proper management can result in a favorable outcome.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Serial chest X-rays showed: (A) infiltrates and consolidations in bilateral lungs with lower lobe predominance on the first day in the emergency department; (B) deterioration of bilateral lungs, for which noninvasive ventilator support was used; (C) improvement in bilateral infiltrates 1 week after discontinuing mesalazine and the initiation of steroid therapy; (D) resolution of most infiltrates in bilateral lungs about 2 months after the onset of symptoms.
Figure 2
Figure 2
A computed tomography scan revealed: (A) diffuse peribronchial and subpleural consolidations in bilateral lungs with disease progression; (B) resolution of most infiltrates 3 months later.
Figure 3
Figure 3
A transbronchial lung biopsy showed mild chronic inflammation with organizing pneumonia (arrow).
See this image and copyright information in PMC

References

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