Mesalazine
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Bronchiolitis obliterans organising pneumonia: case report A 25-year-old man developed a pulmonary complication of ulcerative colitis suggestive of bronchiolitis obliterans organising pneumonia while receiving mesalazine. The man, who had a 4-year history of ulcerative colitis and primary sclerosing cholangitis, presented with a 4-week history of intermittent pleural chest pains. He also reported night sweats, a productive cough and some weight loss during this time. His last flare of ulcerative colitis had occurred over a month before the onset of the respiratory symptoms. He had been treated with azathioprine and occasional courses of mesalazine [route and dosage not stated] since the diagnosis. Routine blood tests revealed raised inflammatory markers and deteriorating liver function. A chest x-ray in October 2010 was reported as normal, but one performed in May 2011 demonstrated right middle zone opacity. A CT scan at that time was reported as revealing multiple bilateral lung nodules with minor ground glass changes around them. The lung nodules were believed to be due to an infective process, possibly as a result of immunosuppression. It was thought to be most likely that the nodules were due to vasculitis or mesalazine-induced variant of Wegener’s granulomatosis. The latter was supported by the patient being positive for cANCA and proteinase 3 antibodies. Histological analysis of a thoracoscopic surgery biopsy was suggestive of bronchiolitis obliterans organising pneumonia. No evidence of a vasculitic process was present. The man was initiated on prednisolone and his symptoms markedly improved. Author comment: "The aetiology is thought to be related to the treatment with mesalazine". Talwar A, et al. A case presentation of a pulmonary complication of ulcerative colitis. BMJ Case Reports : No. 5806, Jan 2013. Available from: URL: http:// 803083412 dx.doi.org/10.1136/bcr-02-2012-5806 - United Kingdom
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Reactions 23 Feb 2013 No. 1440
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