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Case Reports
. 2019 May 27:27:100865.
doi: 10.1016/j.rmcr.2019.100865. eCollection 2019.

A case report of mesalazine-induced lung injury: A reversible drug side effect

Ourania S Kotsiou  1 , Konstantinos I Gourgoulianis  1
Affiliations
Case Reports

A case report of mesalazine-induced lung injury: A reversible drug side effect

Ourania S Kotsiou et al. Respir Med Case Rep. .

Abstract

Introduction: Mesalazine is widely used in the treatment of the acute and maintenance phase of ulcerative colitis (UC). The possibility of interstitial lung disease being induced by mesalazine in the form of eosinophilic pneumonia, organizing pneumonia, and nonspecific interstitial pneumonia has been acknowledged for decades. However, mesalazine-related hypersensitivity pneumonitis (HP) constitutes an infrequent entity.

Case report: A 55-year-old Caucasian man, with a six-month medical history of UC under long-term maintenance treatment with oral mesalazine, presented with a week-long low-grade fever, dry cough and a diffuse bilateral centrilobular ill-defined micronodular pattern in chest imaging. On examination, he had dyspnea with hypoxemic respiratory failure. After extensive workup, potential differential diagnoses such as pulmonary infections were ruled out. Bronchoalveolar lavage (BAL) cellular analysis demonstrated a predominance of lymphocytes and an eosinophilia. The transbronchial biopsy findings confirmed lymphocytic alveolitis. The diagnosis of subacute HP was made with confidence because of the compatible clinical, radiographic, physiologic, BAL and histopathologic findings. Mesalazine withdrawal was decided. Substantial clinical improvement was promptly noticed. The fever abated within 24 hours alongside with a significant improvement of arterial oxygen saturation and lung function parameters. A radiological recovery was also gradually noticed.

Conclusions: Mesalazine-induced HP has been scarcely described in the literature. This Case indicates that HP is a rare but real entity in UC patients on continuous oral mesalazine treatment; its possibility should also be considered when unexplained respiratory symptoms develop during therapy. Amelioration of symptoms, imaging, and lung function improvement seem to occur only upon the abrupt drug discontinuation.

Keywords: BAL, Bronchoalveolar lavage; Drug reaction; FEV1, Forced expiratory volume-one second; HP, Hypersensitivity pneumonitis; HRCT, High-resolution computed tomography; Hypersensitivity pneumonitis; Lung injury; Mesalazine; PaCO2, Partial pressure of carbon dioxide; PaO2, Partial pressure of oxygen; RT-PCR, Reverse transcriptase polymerase chain reaction; UC, Ulcerative colitis; Ulcerative colitis.

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Figures

Fig. 1
Fig. 1
Chest X-ray revealed bilateral interstitial micronodular pattern.
Fig. 2
Fig. 2
Chest high-resolution computed tomography. Diffuse low attenuation micronodular pattern.
Fig. 3
Fig. 3
Photomicrograph of the histopathologic specimen at transbronchial biopsy shows diffuse, bronchiolocentric lymphocytic inflammatory alveolitis (H and E, ×60).
Fig. 4
Fig. 4
Resolution of the micronodular pattern after mesalazine discontinuation. A. One month later. B. Three months later.
See this image and copyright information in PMC

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