Mesalazine
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Bronchiolitis obliterans organising pneumonia: case report A 31-year-old pregnant woman developed bronchiolitis obliterans organising pneumonia while receiving mesalazine for ulcerative colitis. The woman began receiving mesalazine 4 g/day. After a few days, she started to develop a slight fever, dyspnoea and bilateral chest pain. Her symptoms continued to develop gradually and, after 9 months, she was hospitalised. A CT pulmonary angiogram revealed small areas of parenchymal air space opacity in both her lower lobes. Three months later, she was hospitalised again with a low-grade fever, bilateral chest pain and dyspnoea. She had bilateral basal chest dullness to percussion. A chest x-ray revealed bibasal pulmonary/pleural opacities that were more marked on her right side. A chest ultrasound showed minimal pleural effusions. She had an antinuclear antibody titre of > 1280 with a chromosomepositive, diffuse pattern. The woman received amoxicillin, but she did not improve. Mesalazine was discontinued, and she began receiving prednisone. Her symptoms improved within a few days. After 1 month, her x-ray showed considerable improvement and her symptoms had resolved. Three months later, she had resumed all her normal activities, and her chest x-ray was normal. Author comment: "This sequence of events is highly suggestive that mesalazine was the underlying cause of the [bronchiolitis obliterans organising pneumonia]." Menzies O, et al. Colitis and bronchiolitis obliterans organising pneumonia - the treatment or the disease? New Zealand Medical Journal 119: 39-41, No. 1241, 8 801047883 Sep 2006 - New Zealand
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Reactions 21 Oct 2006 No. 1124
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