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Recurrent Pleuropericarditis Associated with Mesalazine Therapy Masked by Steroid Use
Hakan Demiröz1, Hasan Eruzun2, Handan Doğan Çakmak3
1Department of Gastroenterology, Ondokuz Mayıs University, Samsun, Turkey.
Summary
Mesalazine can cause rare pleuropericarditis in ulcerative colitis patients. Corticosteroids may mask symptoms, and effusions can mimic infection, delaying diagnosis of this serious drug side effect.
Area of Science:
- Gastroenterology
- Cardiology
- Pulmonology
Background:
- Mesalazine is a primary treatment for ulcerative colitis (UC).
- While generally safe, mesalazine can rarely cause severe cardiopulmonary issues like pleuropericarditis.
Purpose of the Study:
- To report a case of mesalazine-induced pleuropericarditis.
- To highlight diagnostic challenges and atypical presentations of this adverse event.
Main Methods:
- Case report of a patient with UC experiencing recurrent pleuropericarditis.
- Analysis of clinical presentation, diagnostic workup, and response to treatment withdrawal.
Main Results:
- The patient presented with dyspnea and effusions, initially masked by corticosteroids.
- Pericardial fluid showed a neutrophil-dominant profile, mimicking infection.
- Discontinuation of mesalazine led to rapid improvement, confirming drug-induced serositis.
Conclusions:
- Mesalazine-induced pleuropericarditis can be obscured by corticosteroids, delaying diagnosis.
- Atypical neutrophilic effusions can mimic infection, requiring high suspicion in IBD patients.
- Recurrence upon re-exposure strengthens the diagnosis of drug-induced serositis.
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