Mesalazine-Induced Multi-Organ Hypersensitivity
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CASE REPORT
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Mesalazine-Induced Multi-Organ Hypersensitivity Bruno Sposato,1 Maria Pia Allegri,2 Maria Piera Riccardi,2 Silvia Chigiotti,2 Cesira Nencioni,2 Barbara Ricciardi,2 Tiziana Carli,2 Alberto Cresti,3 Maria Grazia Perari,4 Maria Giovanna Migliorini1 and Mario Toti2 1 2 3 4
Unita` Operativa Pneumologia, Ospedale ‘Misericordia’ Grosseto, Grosseto, Italy Unita` Operativa Complessa Malattie Infettive, Ospedale ‘Misericordia’ Grosseto, Grosseto, Italy Unita` Operativa Complessa Cardiologia, Ospedale ‘Misericordia’ Grosseto, Grosseto, Italy Unita` Operativa Complessa Sezione di Malattie Respiratorie, Dipartimento di Medicina Clinica e Scienze Immunologiche, Ospedale ‘Le Scotte’ Universita` di Siena, Siena, Italy
Abstract
Mesalazine therapy for ulcerative colitis has been reported to be effective and safe. Rare cases of mesalazine-induced renal, pancreatic, myo-pericardial, pleuro-pulmonary and haematological toxicity have been described separately. We report a case characterized by the simultaneous presence of fever, pericarditis, peripheral eosinophilia, eosinophilic pneumonia, anaemia and haematuria (together with proteinuria and leukocyturia) due to mesalazine treatment in a patient with ulcerative colitis. No clinical response had been obtained with corticosteroids and various antibacterial agents. When mesalazine treatment was suspended, all symptoms rapidly and totally disappeared, confirming the direct responsibility of this drug in causing these adverse events. We conclude that mesalazine can induce multi-organ hypersensitivity, which must always be considered as a possible adverse effect during treatment with this drug. To resolve this adverse event it is essential to discontinue mesalazine treatment.
Mesalazine (5-aminosalicylic acid) is a drug used in the treatment of chronic inflammatory bowel disease (ulcerative colitis and Crohn’s disease).[1] In both oral and topical formulations it is effective for the remission of active colitis and the maintenance of this remission, regardless of the extent of inflammation.[1] Mesalazine is a byproduct of sulfasalazine (salazopyrin) which lacks the sulfamidic vector responsible for the major collateral effects of sulfasalazine. As a consequence, only occasional symptoms of nausea, diarrhoea, abdominal pain and headache have been reported.[2] Furthermore, serious adverse events are extremely rare in mesa-
lazine-treated patients, with only a small number of cases of renal,[2,3] pancreatic,[4] myo-pericardial[5,6] and pulmonary[7-9] toxicity, as well as haematological disorders (including agranulocytosis, aplastic anaemia, leukopenia, neutropenia and thrombocytopenia),[10,11] having been described. To date, such adverse events have never been described as occurring together. In the present report, we describe a case characterized by the simultaneous presence of pericarditis, eosinophilic pneumonia, peripheral eosinophilia, anaemia and haematuria due to mesalazine treatment in a patient with ulcerative co
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