Pulmonary toxicity to mesalazine
M. Araújo Pereira (Braga, Portugal), M. Araújo (Braga, Portugal), F. Lemos Aguiar (Braga, Portugal), J. Vale Lages (Braga, Portugal), A. Vieira (Braga, Portugal), J. Cruz (Braga, Portugal)
Source: International Congress 2018 – Pitfalls in the diagnosis and management of rare diffuse parenchymal lung diseases (DPLDs)
Disease area: Interstitial lung diseases
Abstract Introduction:
Pulmonary involvement of inflammatory bowel disease (IBD) is a rare entity and should be distinguished from the infectious complications and adverse effects of the medication, namely mesalazine.
Case report:
23-year-old non-smoking woman. Diagnosis of Ulcerative Colitis since 2013, medicated with mesalazine (2g / day). No respiratory symptoms until 2017, when started progressive dyspnea and left thoracalgia, with nonspecific characteristics, without other symptoms. Physical examination was unremarkable. A chest radiography revealed bilateral patchy opacities, arterial blood gas analysis without respiratory insufficiency, and blood tests showed elevation of CRP, without other changes of relief. A chest CT revealed bilateral nodular consolidations areas, with surrounding ground glass and air bronchogram. Bronchofibroscopy was normal. Bronchoalveolar lavage reveal hypercellularity with predominance of lymphocytes (66%) with CD4 / CD8 ratio of 5.8. Septic screening was negative, as was the serological and immunological study. Pulmonary function test was normal, with a slight decrease in DLCO (66%). Transthoracic pulmonary biopsy revealed pulmonary parenchyma with interstitial fibrosis and inflammatory infiltrate of monucleate predominance, morphological aspects compatible with organizing pneumonia. Thus, given the histological changes compatible with organizing pneumonia of probable toxic etiology, treatment with mesalazine was discontinued. After this period, no clinically respiratory symptoms and the follow-up chest CT showed complete imaging resolution.
Discussion:
Mesalazine-induced lung toxicity is a rare entity, but should be considered in patients with IBD and who develop unexplained respiratory lesions while taking this medication.
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M. Araújo Pereira (Braga, Portugal), M. Araújo (Braga, Portugal), F. Lemos Aguiar (Braga, Portugal), J. Vale Lages (Braga, Portugal), A. Vieira (Braga, Portugal), J. Cruz (Braga, Portugal). Pulmonary toxicity to mesalazine. 3027
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