Mesalazine
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Lung injury: case report A 58-year-old woman developed lung injury during treatment with mesalazine for ulcerative colitis (UC). The woman, who had UC, had been receiving mesalazine 2400mg daily [route not stated] for 2 months and transferred to the current hospital due to unresolved pneumonia. On admission, she had a fever, wet cough and dyspnoea on exertion for a week. She did not have a history of smoking, allergy to medications and other medical illnesses. Initial investigations showed vital signs as the temperature of 38.30C, respiratory rate 24 breaths/minute, and O2 saturation 91% on 4 L/min oxygen via nasal cannula. Fine crackles were observed in the bilateral lung fields without evidence of clubbing, skin rash or peripheral oedema. Further laboratory investigations showed as followed: WBC count 22000 /mm3 with 88% neutrophils, 8% lymphocytes, and 3% eosinophils, haemoglobin of 9.4 g/dL, platelet count of 1150000 /mm3, serum CRP 15.26 mg/dL, Krebs von den Lungen-6 (KL-6) 224 U/mL and surfactant protein-D (SP-D) 130 ng/mL. Arterial blood gas analysis revealed partial pressure of carbon dioxide (PaCO2) of 30.1mm Hg and partial pressure of oxygen (PaO2) of 70.8mm Hg with 4 L/min oxygen via nasal cannula. A chest CT scan revealed bilateral and asymmetric air space consolidation and ground-glass opacity with a peribronchial and subpleural distribution. A bronchoalveolar lavage (BAL) fluid analysis was found to be negative. Transbronchial lung biopsy (TBLB) was performed and histopathological findings demonstrated patchy processes characterised primarily by organizing pneumonia involving alveolar ducts and alveoli with bronchiolar intraluminal polyps. Further investigations were found to be negative. In view of presenting symptoms and investigational findings, she was suspected to have organising pneumonia of UC or mesalazine-induced lung injury. On the day of admission, the woman’s mesalazine treatment was stopped. She was treated with methylprednisolone pulse therapy followed by low dose prednisolone. Due to the severe respiratory failure, she was immediately initiated on non-invasive positive pressure ventilation (NPPV). Additionally, she also developed mild acute respiratory distress syndrome (ARDS) and organising pneumonia. Eventually, improvement in her condition was noted and NPPV was discontinued on day 11. Later, her respiratory status was fully resolved and she was discharged from the hospital on day 25. Thereafter, improvement in her UC was noted and no medication had been needed for the next 3 years. Based on symptoms, findings and diagnostic criteria, she was diagnosed with mesalazine-induced lung injury [duration of treatment to reaction onset not stated]. Additionally, she had been free from relapse of lung injury. Oi H, et al. Mesalazine-induced lung injury with severe respiratory failure successfully treated with steroids and non-invasive positive pressure ventilation. Respiratory 803504459 Medicine Case Reports 31: 1-5, 2020. Available from: URL: http://doi.org/10.1016/j.rmcr.2020.101157
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