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Acute eosinophilic pneumonia related to a mesalazine suppository.

Kim JH, Lee JH, Koh ES, Park SW, Jang AS, Kim D, Park CS - Asia Pac Allergy (2013)

Bottom Line: Topical products of these limited systemic absorption and have less frequent side effects, therefore suppository form of these drugs have been used more than systemic drug.Most cases of measalzine-induced lung toxicity develop from systemic use of the drug.She was recovered after stopping of mesalazine suppository and treatment with systemic steroid.

View Article: PubMed Central - PubMed

Affiliation: Division of Respiratory and Allergy, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 420-767, Korea.

ABSTRACT
It has been well known that mesalazine can cause the interstitial lung disease, such as Bronchiolitis obliterans with organizing pneumonia (BOOP), Non-Specific Interstitial Pneumonia (NSIP), or eosinophilic pneumonia. 5-Aminosalicylic acid (5-ASA), mesalazine, and sulfasalazine are important drugs for treating inflammatory bowel disease. Topical products of these limited systemic absorption and have less frequent side effects, therefore suppository form of these drugs have been used more than systemic drug. Most cases of measalzine-induced lung toxicity develop from systemic use of the drug. A 30-year-old woman had an interstitial lung disease after using mesalazine suppository because of ulcerative colitis. The lung biopsy demonstrated eosinophilic pneumonia combined with BOOP. She was recovered after stopping of mesalazine suppository and treatment with systemic steroid.

No MeSH data available.


Related in: MedlinePlus

(A) Many chronic inflammatory cells (predominantly macrophages) and some aggregation of eosinophils are seen. (B) Interstitial thickenings with chronic inflammatory cells infiltration and intraluminal young fibroblastic polyps, that are consistent with Bronchiolitis obliterans with organizing pneumonia, are also seen.
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Figure 1: (A) Many chronic inflammatory cells (predominantly macrophages) and some aggregation of eosinophils are seen. (B) Interstitial thickenings with chronic inflammatory cells infiltration and intraluminal young fibroblastic polyps, that are consistent with Bronchiolitis obliterans with organizing pneumonia, are also seen.

Mentions: A 30-year-old woman presented with cough that was aggravated at night for 10 days. She had ulcerative colitis and had undergone a left hemi-colectomy with a colostomy 7 weeks ago. She had received a mesalazine suppository (1 g/day) for 19 days after the operation. At the time of presentation, the patient complained of fatigue, general weakness, myalgia, cough, and a small amount of non-purulent sputum. A chest X-ray and high resolution computed tomography showed peripheral patchy consolidations with interlobular septal thickening in both lungs. Blood eosinophils were 24.5%, level of total IgE was 169 KU/L and specific IgE for dust mites were 3+ in UniCAP system. Total cell count was 31.5 × 105 cell/mL with 73.2% macrophages, 19.6% neutrophils, 1.6% eosinophils, 0% lymphocytes in bronchoalveolar lavage fluid. Tests for nine respiratory associated viruses (adenovirus; Rous sarcoma virus; rhinovirus; metapneumovirus; seasonal influenza A and B; parainfluenza virus 1, 2, and 3; and novel H1N1 virus) were all negative by real-time PCR. Test results for antinuclear antibodies, rheumatoid factor, anti-ds DNA antibody, and antineutrophil cytoplasmic antibody were negative. The lung biopsy demonstrated that a patchy interstitial and intra-alveolar histiocytic infiltration was admixed with many eosinophils and some neutrophils and foci of organizing fibrosis, suggestive of eosinophilic pneumonia and BOOP (Fig. 1). The mesalazine suppository was stopped. She was treated with 500 mg methylprednisolone intravenously for 3 days followed by 30 mg prednisolone orally. She recovered completely.


Acute eosinophilic pneumonia related to a mesalazine suppository.

Kim JH, Lee JH, Koh ES, Park SW, Jang AS, Kim D, Park CS - Asia Pac Allergy (2013)

(A) Many chronic inflammatory cells (predominantly macrophages) and some aggregation of eosinophils are seen. (B) Interstitial thickenings with chronic inflammatory cells infiltration and intraluminal young fibroblastic polyps, that are consistent with Bronchiolitis obliterans with organizing pneumonia, are also seen.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3643058&req=5

Figure 1: (A) Many chronic inflammatory cells (predominantly macrophages) and some aggregation of eosinophils are seen. (B) Interstitial thickenings with chronic inflammatory cells infiltration and intraluminal young fibroblastic polyps, that are consistent with Bronchiolitis obliterans with organizing pneumonia, are also seen.
Mentions: A 30-year-old woman presented with cough that was aggravated at night for 10 days. She had ulcerative colitis and had undergone a left hemi-colectomy with a colostomy 7 weeks ago. She had received a mesalazine suppository (1 g/day) for 19 days after the operation. At the time of presentation, the patient complained of fatigue, general weakness, myalgia, cough, and a small amount of non-purulent sputum. A chest X-ray and high resolution computed tomography showed peripheral patchy consolidations with interlobular septal thickening in both lungs. Blood eosinophils were 24.5%, level of total IgE was 169 KU/L and specific IgE for dust mites were 3+ in UniCAP system. Total cell count was 31.5 × 105 cell/mL with 73.2% macrophages, 19.6% neutrophils, 1.6% eosinophils, 0% lymphocytes in bronchoalveolar lavage fluid. Tests for nine respiratory associated viruses (adenovirus; Rous sarcoma virus; rhinovirus; metapneumovirus; seasonal influenza A and B; parainfluenza virus 1, 2, and 3; and novel H1N1 virus) were all negative by real-time PCR. Test results for antinuclear antibodies, rheumatoid factor, anti-ds DNA antibody, and antineutrophil cytoplasmic antibody were negative. The lung biopsy demonstrated that a patchy interstitial and intra-alveolar histiocytic infiltration was admixed with many eosinophils and some neutrophils and foci of organizing fibrosis, suggestive of eosinophilic pneumonia and BOOP (Fig. 1). The mesalazine suppository was stopped. She was treated with 500 mg methylprednisolone intravenously for 3 days followed by 30 mg prednisolone orally. She recovered completely.

Bottom Line: Topical products of these limited systemic absorption and have less frequent side effects, therefore suppository form of these drugs have been used more than systemic drug.Most cases of measalzine-induced lung toxicity develop from systemic use of the drug.She was recovered after stopping of mesalazine suppository and treatment with systemic steroid.

View Article: PubMed Central - PubMed

Affiliation: Division of Respiratory and Allergy, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 420-767, Korea.

ABSTRACT
It has been well known that mesalazine can cause the interstitial lung disease, such as Bronchiolitis obliterans with organizing pneumonia (BOOP), Non-Specific Interstitial Pneumonia (NSIP), or eosinophilic pneumonia. 5-Aminosalicylic acid (5-ASA), mesalazine, and sulfasalazine are important drugs for treating inflammatory bowel disease. Topical products of these limited systemic absorption and have less frequent side effects, therefore suppository form of these drugs have been used more than systemic drug. Most cases of measalzine-induced lung toxicity develop from systemic use of the drug. A 30-year-old woman had an interstitial lung disease after using mesalazine suppository because of ulcerative colitis. The lung biopsy demonstrated eosinophilic pneumonia combined with BOOP. She was recovered after stopping of mesalazine suppository and treatment with systemic steroid.

No MeSH data available.


Related in: MedlinePlus