Mesalazine
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Churg-Strauss syndrome: case report A 39-year-old man with Crohn’s disease and sclerosing cholangitis developed Churg-Strauss syndrome during treatment with mesalazine. The man, who had a long history of atopic rhinitis, asthma and nasal polyposis, presented with fever, weakness, weight loss, vertigo, paraesthesias and arthralgias 10 months after starting mesalazine [dosage not stated]. His eosinophil count was 12 124 × mm3 [sic] (56% of total), his C-reactive protein level was 7 mg/L (normal < 5), his erythrocyte sedimentation rate (ESR) was 41 and urinalysis showed 1+ haematuria. A skull MRI showed pansinusitis and a CT lung scan revealed initial centrolobular emphysema. Pulmonary function tests showed mild obstructive disease. Peripheral nerve electromyography indicated mononeuritis multiplex. A bone marrow biopsy revealed extensive eosinophilic infiltration. A stool specimen showed Blastocystis hominis and the man was discharged with metronidazole. However, he was readmitted 1 month later due to worsening vertigo. Laboratory investigations confirmed increased inflammatory markers and eosinophilia (46.4%). An examination showed vestibular decompensation and right perceptive hypacusia. He subsequently developed a left third cranial nerve palsy and spontaneous nystagmus. A repeat skull MRI revealed multiple small ischaemic lesions. Churg-Strauss syndrome was diagnosed and he received prednisone. A prompt clinical improvement ensued, with normalisation of his eosinophila and inflammatory markers. Mesalazine was discontinued. At follow-up 8 months after diagnosis, he was receiving prednisone and was well, with a normal ESR, eosinophil count and C-reactive protein level. Author comment: "Even though we could not demonstrate a cause-effect relationship between mesalazine and Churg-Strauss syndrome, we believe that our patient’s illness was probably caused by his drug because of its capacity to induce eosinophil activation and hypersensitivity reactions." Sinico RA, et al. Mesalazine-induced Churg-Strauss syndrome in a patient with Crohn’s disese and sclerosing cholangitis. Clinical and Experimental 801046074 Rheumatology 24 (Suppl. 41): 104, No. 2, Mar-Apr 2006 - Italy
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Reactions 30 Sep 2006 No. 1121
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