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Acute eosinophilic pneumonia related to a mesalazine suppository

Jung Hyun Kim1, June-Hyuk Lee, Eun-Suk Koh

  • 1Division of Respiratory and Allergy, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 420-767, Korea.

Asia Pacific Allergy
|May 14, 2013
PubMed

Insights

Mesalazine suppositories, used for ulcerative colitis, can cause interstitial lung disease like eosinophilic pneumonia and Bronchiolitis obliterans with organizing pneumonia (BOOP). Prompt cessation and steroid treatment led to recovery.

Area of Science:

  • Pulmonology
  • Gastroenterology
  • Pharmacology

Background:

  • Mesalazine (5-aminosalicylic acid) is a key treatment for inflammatory bowel disease.
  • Topical mesalazine formulations, like suppositories, offer localized treatment with reduced systemic absorption and side effects compared to oral forms.
  • Mesalazine is known to cause interstitial lung diseases, including Bronchiolitis obliterans with organizing pneumonia (BOOP), Non-Specific Interstitial Pneumonia (NSIP), and eosinophilic pneumonia.

Observation:

  • A 30-year-old female patient with ulcerative colitis developed interstitial lung disease.
  • The patient had been using mesalazine suppositories for her condition.
  • Lung biopsy revealed a combination of eosinophilic pneumonia and BOOP.

Findings:

  • Mesalazine-induced lung toxicity can occur even with topical suppository use.
  • The patient's lung biopsy confirmed a mixed pattern of eosinophilic pneumonia and BOOP.
  • Discontinuation of mesalazine suppositories and initiation of systemic steroid therapy resulted in clinical improvement.

Implications:

  • This case highlights the potential for mesalazine suppositories to induce serious lung toxicity.
  • Clinicians should consider mesalazine-induced lung disease in patients using suppositories who present with respiratory symptoms.
  • Early diagnosis and withdrawal of the offending agent, along with appropriate treatment, are crucial for managing mesalazine-related pulmonary complications.
Keywords:
Bronchiolitis obliterans with organizing pneumoniaEosinophilic pneumoniaMesalazineSuppository

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