5-Aminosalicylic Acid-induced Colitis in a Patient with Rheumatoid Arthritis without Inflammatory Bowel Disease

Area of Science:

• Gastroenterology
• Clinical Medicine
• Pharmacology

Background:

• 5-aminosalicylic acid (5-ASA) is commonly used to treat inflammatory bowel disease (IBD).
• Drug-induced colitis is a known adverse effect, but typically associated with IBD.
• Rheumatoid arthritis patients may receive 5-ASA derivatives for comorbidities.

Purpose of the Study:

• To report a rare case of 5-ASA-induced colitis in a patient without a history of IBD.
• To emphasize the importance of considering 5-ASA intolerance in non-IBD patients presenting with gastrointestinal symptoms.

Main Methods:

• Case report of a 76-year-old male patient.
• Clinical evaluation including history of drug intake (sulfasalazine, mesalazine).
• Diagnostic testing: Drug-induced lymphocyte stimulation test (DLST).

Main Results:

• The patient developed persistent diarrhea and fever after sulfasalazine and mesalazine administration.
• The DLST was positive for mesalazine and weakly positive for sulfasalazine.
• Diagnosis of 5-ASA intolerance was confirmed.

Conclusions:

• 5-ASA-induced colitis can occur in patients without pre-existing IBD.
• Clinicians should maintain a high index of suspicion for 5-ASA intolerance in patients with unexplained GI symptoms after initiating 5-ASA therapy.
• This diagnosis should be considered even in the absence of IBD history.