Asia Pac Allergy.  2013 Apr;3(2):136-139. 10.5415/apallergy.2013.3.2.136.

Acute eosinophilic pneumonia related to a mesalazine suppository

• Kim JH
• Lee JH
• Koh ES
• Park SW
• Jang AS
• Kim D
• Park CS

• KMID: 2400410
• DOI: http://doi.org/10.5415/apallergy.2013.3.2.136

Abstract

It has been well known that mesalazine can cause the interstitial lung disease, such as Bronchiolitis obliterans with organizing pneumonia (BOOP), Non-Specific Interstitial Pneumonia (NSIP), or eosinophilic pneumonia. 5-Aminosalicylic acid (5-ASA), mesalazine, and sulfasalazine are important drugs for treating inflammatory bowel disease. Topical products of these limited systemic absorption and have less frequent side effects, therefore suppository form of these drugs have been used more than systemic drug. Most cases of measalzine-induced lung toxicity develop from systemic use of the drug. A 30-year-old woman had an interstitial lung disease after using mesalazine suppository because of ulcerative colitis. The lung biopsy demonstrated eosinophilic pneumonia combined with BOOP. She was recovered after stopping of mesalazine suppository and treatment with systemic steroid.

Keyword

Eosinophilic pneumonia; Bronchiolitis obliterans with organizing pneumonia; Mesalazine; Suppository

MeSH Terms

Absorption, Physiological
Adult
Biopsy
Bronchiolitis Obliterans
Colitis, Ulcerative
Cryptogenic Organizing Pneumonia
Eosinophils*
Female
Humans
Inflammatory Bowel Diseases
Lung
Lung Diseases, Interstitial
Mesalamine*
Pneumonia
Pulmonary Eosinophilia*
Sulfasalazine
Mesalamine
Sulfasalazine

Figure

• 

  Fig. 1 (A) Many chronic inflammatory cells (predominantly macrophages) and some aggregation of eosinophils are seen. (B) Interstitial thickenings with chronic inflammatory cells infiltration and intraluminal young fibroblastic polyps, that are consistent with Bronchiolitis obliterans with organizing pneumonia, are also seen.

Reference

1. Parry SD, Barbatzas C, Peel ET, Barton JR. Sulphasalazine and lung toxicity. Eur Respir J. 2002. 19:756–764.

2. Foster RA, Zander DS, Mergo PJ, Valentine JF. Mesalamine-related lung disease: clinical, radiographic, and pathologic manifestations. Inflamm Bowel Dis. 2003. 9:308–315.

3. Brimblecombe R. Mesalazine: a global safety evaluation. Scand J Gastroenterol Suppl. 1990. 172:66.

4. Salerno SM, Ormseth EJ, Roth BJ, Meyer CA, Christensen ED, Dillard TA. Sulfasalazine pulmonary toxicity in ulcerative colitis mimicking clinical features of Wegener's granulomatosis. Chest. 1996. 110:556–559.

5. Tanigawa K, Sugiyama K, Matsuyama H, Nakao H, Kohno K, Komuro Y, Iwanaga Y, Eguchi K, Kitaichi M, Takagi H. Mesalazine-induced eosinophilic pneumonia. Respiration. 1999. 66:69–72.

6. Camus P, Colby TV. The lung in inflammatory bowel disease. Eur Respir J. 2000. 15:5–10.

7. Carter MJ, Lobo AJ, Travis SP. IBD Section, British Society of Gastroenterology. Guidelines for the management of inflammatory bowel disease in adults. Gut. 2004. 53:Suppl 5. V1–V16.

8. Sviri S, Gafanovich I, Kramer MR, Tsvang E, Ben-Chetrit E. Mesalamine-induced hypersensitivity pneumonitis. A case report and review of the literature. J Clin Gastroenterol. 1997. 24:34–36.

9. Isaacs KL, Murphy D. Pancreatitis after rectal administration of 5-aminosalicylic acid. J Clin Gastroenterol. 1990. 12:198–199.

10. Kim KH, Kim TN, Jang BI. A case of acute pancreatitis caused by 5-aminosalicylic acid suppositories in a patient with ulcerative colitis. Korean J Gastroenterol. 2007. 50:379–383.

11. Borum ML, Ginsberg A. Hypersensitivity to 5-ASA suppositories. Dig Dis Sci. 1997. 42:1076–1078.

12. Qureshi AI, Cohen RD. Mesalamine delivery systems: do they really make much difference? Adv Drug Deliv Rev. 2005. 57:281–302.

13. Aumais G, Lefebvre M, Tremblay C, Bitton A, Martin F, Giard A, Madi M, Spénard J. Rectal tissue, plasma and urine concentrations of mesalazine after single and multiple administrations of 500 mg suppositories to healthy volunteers and ulcerative proctitis patients. Aliment Pharmacol Ther. 2003. 17:93–97.

14. Williams CN, Haber G, Aquino JA. Double-blind, placebo-controlled evaluation of 5-ASA suppositories in active distal proctitis and measurement of extent of spread using 99mTc-labeled 5-ASA suppositories. Dig Dis Sci. 1987. 32:71S–75S.

15. Physicians' desk reference. 2004. 58th ed. Montvale, NJ: Thomson PDR;795–796.