Tuberc Respir Dis.  2012 Mar;72(3):323-327.

A Case of Balsalazide-Induced Limited Form of Granulomatosis with Polyangiitis with Bronchiolitis Obliterans Organizing Pneumonia-like Variant in Ulcerative Colitis

• Kang SM
• Jang YR
• Yoon HH
• Kim S
• Kim EY
• Ha SY
• Park JW

Abstract

5-Aminosalicylate agents are the main therapeutic agents for ulcerative colitis. Balsalazide is a prodrug of 5-aminosalicylate and has fewer side effects than the other 5-aminosalicylate agents. Pulmonary complications resembling granulomatosis with polyangiitis in ulcerative colitis are extremely rare. Here, we report a patient with ulcerative colitis on balsalazide presenting respiratory symptoms and multiple pulmonary nodules from a chest radiography that was pathologically diagnosed with a limited form of granulomatosis with polyangiitis with bronchiolitis obliterans organizing pneumonia-like variant. To our knowledge, this is the first report of a balsalazide-induced limited form of granulomatosis with polyangiitis with bronchiolitis obliterans organizing pneumonia-like variant.

Keyword

Balsalazide; Wegener Granulomatosis; Colitis, Ulcerative

MeSH Terms

Bronchiolitis
Bronchiolitis Obliterans
Colitis, Ulcerative
Humans
Mesalamine
Multiple Pulmonary Nodules
Phenylhydrazines
Thorax
Ulcer
Wegener Granulomatosis
Mesalamine
Phenylhydrazines

Figure

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  Figure 1 Chest radiography shows multiple nodular opacities of varying size in both lungs.

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  Figure 2 (A) Initial chest computed tomography (CT) image shows multiple nodular infiltrates located predominantly in the periphery of both lower lobes and a small amount of pleural effusion in the left hemithorax. (B) Three months after the discontinuation of balsalazide, a chest CT shows marked improvements or complete resolution of nodular infiltrates in both lungs and disappearance of the left pleural effusion.

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  Figure 3 (A) Extensive necrosis with plugs of fibroblasts and fibrin within the alveolar space and alveolar duct look like BOOP (H&E stain, ×100). (B) High magnification shows a small granuloma with multinucleated giant cells (H&E stain, ×200). BOOP: bronchiolitis obliterans organizing pneumonia.

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