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Ulcerative colitis flair induced by mesalamine suppositories hypersensitivity.

Hao Ding1, Xiao-Chang Liu1, Qiao Mei1

  • 1Hao Ding, Xiao-Chang Liu, Qiao Mei, Jian-Ming Xu, Jing Hu, Department of Gastroenterology, First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China.

World Journal of Gastroenterology
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Mesalamine suppositories, used for ulcerative colitis, can cause severe hypersensitivity reactions. This case highlights the need for vigilance regarding potential adverse effects even with localized treatments.

Keywords:
HypersensitivityMesalamine suppositoriesSulfasalazineSurgeryUlcerative colitis

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Area of Science:

  • Gastroenterology
  • Clinical Pharmacology

Background:

  • Mesalamine suppositories are a common treatment for distal ulcerative colitis due to limited systemic absorption.
  • While generally safe, mesalamine suppositories have been linked to severe hypersensitivity reactions in some patients.

Observation:

  • A 25-year-old woman experienced worsening ulcerative colitis symptoms, including bloody diarrhea, abdominal pain, and fever, after starting mesalamine suppositories.
  • Clinical evaluation revealed exacerbated colitis, increased mucosal inflammation via colonoscopy, and elevated peripheral eosinophil counts.

Findings:

  • The patient's presentation and diagnostic findings strongly suggest a hypersensitivity reaction to mesalamine suppositories.
  • The Naranjo algorithm score indicated a definite adverse drug reaction.

Implications:

  • This case underscores the potential for severe hypersensitivity reactions to mesalamine suppositories, even when administered locally.
  • Healthcare providers should maintain awareness of these risks and consider mesalamine hypersensitivity in patients with worsening colitis symptoms.
  • Further vigilance is warranted for all mesalamine formulations, including suppositories, regarding potential adverse reactions.