Pediatr Gastroenterol Hepatol Nutr.  2015 Dec;18(4):286-291. 10.5223/pghn.2015.18.4.286.

Mesalizine-Induced Acute Pancreatitis and Interstitial Pneumonitis in a Patient with Ulcerative Colitis

• Chung MJ
• Lee JH
• Moon KR

• KMID: 2383308
• DOI: http://doi.org/10.5223/pghn.2015.18.4.286

Abstract

Ulcerative colitis (UC) is a chronic idiopathic inflammatory bowel disease. Mesalizine for the first-line therapy of UC has adverse effects include pancreatitis, pneumonia and pericarditis. UC complicated by two coexisting conditions, however, is very rare. Moreover, drug-related pulmonary toxicity is particularly rare. An 11-year-old male patient was hospitalized for recurring upper abdominal pain after meals with vomiting, hematochezia and exertional dyspnea developing at 2 weeks of mesalizine therapy for UC. The serum level of lipase was elevated. Chest X-ray and thorax computed tomography showed interstitial pneumonitis. Mesalizine was discontinued and steroid therapy was initiated. Five days after admission, symptoms were resolved and mesalizine was resumed after a drop in amylase and lipase level. Symptoms returned the following day, however, accompanied by increased the serum levels of amylase and lipase. Mesalizine was discontinued again and recurring symptoms rapidly improved.

Keyword

Inflammatory bowel diseases; Ulcerative colitis; Pancreatitis; Interstitial lung disease; Mesalizine

MeSH Terms

Abdominal Pain
Amylases
Child
Colitis, Ulcerative*
Dyspnea
Gastrointestinal Hemorrhage
Humans
Inflammatory Bowel Diseases
Lipase
Lung Diseases, Interstitial*
Male
Meals
Pancreatitis*
Pericarditis
Pneumonia
Thorax
Ulcer*
Vomiting
Amylases
Lipase

Figure

• 

  Fig. 1 Colonoscopy demonstrates diffuse symmetric erythematous mucosa with exudates from cecum to sigmoid colon, shallow ulcer at transverse colon.

• 

  Fig. 2 (A) Thorax computed tomography (CT) scan demonstrates nodular ground glass opacities in left lower lung zone periphery (arrow). (B) The lesion disappeared at follow-up CT scan 1 month later.

• 

  Fig. 3 Pulmonary function test revealed moderate to severe restriction (FVC 1.56 L [43% predicted], FEV1 1.41 L [42% predicted], and FEV1/FVC 91%). FVC: forced vital capacity, FEV1: forced expiratory volume-one second, PRE-RX: pre-response to bronchodilator, POST-RX: post-response to bronchodilator, %PRED: percentage of predicted value, %CHG: percentage of change.

• 

  Fig. 4 The clinical courses of the patient. Initially serum levels of amylase and lipase were 64 IU/L and 308 IU/L. Symptoms and biochemical results improved with NPO and discontinuation of mesalizine. However, a similar event recurred with the readministration of 5-aminosalicylic acid (5-ASA). With abdominal pain and fever (38.5℃), serum levels of amylase and lipase increased to 148 IU/L and 325 IU/L. Fever, dyspnea, and abdominal pain subsided and amylase levels returned to normal with NPO and discontinuation of mesalizine. HD: hospital date, PDS: prednisolone, NPO: non per oral intake.

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