Mesalamine-related lung disease: Clinical, radiographic, and pathologic manifestations
Corresponding Author
Dr. Runi A. Foster
Departments of Medicine, University of Florida College of Medicine, Gainesville, Florida
Division of Pulmonary Medicine, University of Florida, PO Box 100225, Gainesville, Florida 32610-0225Search for more papers by this authorDani S. Zander
Departments of Pathology, University of Florida College of Medicine, Gainesville, Florida
Departments of Radiology, University of Florida College of Medicine, Gainesville, Florida
Search for more papers by this authorPatricia J. Mergo
Malcom Randall Veterans Affairs Medical Center, Gainesville, FL
Search for more papers by this authorJohn F. Valentine
Departments of Medicine, University of Florida College of Medicine, Gainesville, Florida
Malcom Randall Veterans Affairs Medical Center, Gainesville, FL
Search for more papers by this authorCorresponding Author
Dr. Runi A. Foster
Departments of Medicine, University of Florida College of Medicine, Gainesville, Florida
Division of Pulmonary Medicine, University of Florida, PO Box 100225, Gainesville, Florida 32610-0225Search for more papers by this authorDani S. Zander
Departments of Pathology, University of Florida College of Medicine, Gainesville, Florida
Departments of Radiology, University of Florida College of Medicine, Gainesville, Florida
Search for more papers by this authorPatricia J. Mergo
Malcom Randall Veterans Affairs Medical Center, Gainesville, FL
Search for more papers by this authorJohn F. Valentine
Departments of Medicine, University of Florida College of Medicine, Gainesville, Florida
Malcom Randall Veterans Affairs Medical Center, Gainesville, FL
Search for more papers by this authorAbstract
Lung injury related to mesalamine (5-aminosalicylic acid) has rarely been reported in patients with inflammatory bowel diseases. Patients present with progressive respiratory symptoms and radiographic abnormalities whose genesis may occur from days to years after initiation of therapy. Although pathologic features overlap with other pulmonary disorders, findings of chronic interstitial pneumonia and poorly formed nonnecrotizing granulomas should prompt consideration of mesalamine-related lung disease in a patient receiving this medication. The authors describe the clinical, radiographic, and pathologic manifestations of mesalamine-related lung disease in three patients and review the literature related to this topic.
References
- 1 Peppercorn MA. Advances in drug therapy for inflammatory bowel disease. Ann Intern Med 1990; 112: 50–60.
- 2 Kaiser GC, Yan F, Polk DB. Mesalamine blocks tumor necrosis factor growth inhibition and nuclear factor kappa B activation in mouse colonocytes. Gastroenterology 1999; 116: 602–9.
- 3 Valentine JF. Mesalamine induces manganese superoxide dismutase in rat intestinal epithelial cell lines and in vivo. Am J Physiol Gastrointest Liver Physiol 2001; 281: G1044–50.
- 4 Watkinson G. Sulphasalazine: a review of 40 years' experience. Drugs 1986; 32 (suppl1): 1–11.
- 5 Hamadeh M, Atkinson J, Smith LJ. Sulfasalazine-induced pulmonary disease. Chest 1992; 101: 1033–7.
- 6 Jones GR, Malone DN. Sulfasalazine induced lung disease. Thorax 1972; 27: 713–7.
- 7
Honeybourne D.
Mesalazine toxicity.
Br Med J
1994;
308:
553–4.
10.1136/bmj.308.6927.533b Google Scholar
- 8 Muzzi A, Ciani F, Bianchini D, et al. Adverse pulmonary effects of mesalamine. Chest 1995; 108: 1181.
- 9 Reinoso MA, Schroeder KW, Pisani RJ. Lung disease associated with orally administered mesalamine for ulcerative colitis. Chest 1992; 101: 1469–71.
- 10 Welte T, Hamm H, Gabel H. Mesalazine alveolitis. Lancet 1991; 338: 1273.
- 11 Sviri S, Gafanovich I, Kramer MR, et al. Mesalamine-induced hypersensitivity pneumonitis. J Clin Gastroenterol 1994; 24: 34–6.
- 12 Limper AH, Rosenow EC. Drug induced pulmonary disease. In: JF Murray, JA Nadel, eds. Textbook of Respiratory Medicine. Philadelphia: WB Saunders, 2000: 1971–94.
- 13 Kuzela L, Vavrecka A, Prikazska M, et al. Pulmonary complications in patients with inflammatory bowel disease. Hepatogastroenterology 1999; 46: 1714–9.
- 14 Greenstein AJ, Janowitz HD, Sachar DB. The extraintestinal manifestations of Crohn's disease and ulcerative colitis: a study of 700 patients. Medicine 1976; 55: 401–12.
- 15 Camus P, Piard F, Ashcroft T, et al. The lung in inflammatory bowel disease. Medicine 1993; 72: 151–80.
- 16 Baillie J. Sulfasalazine and pulmonary infiltrates. Am J Gastroenterol 1984; 79: 77.
- 17 Averbuch M, Halpern Z, Hallak A, et al. Sulfasalazine pneumonitis. Am J Gastroenterol 1985; 80: 343.
- 18 Brimblecombe R. Mesalamine: a global safety evaluation. Scand J Gastroenterol Suppl 1990; 172: 66.
- 19 Tanigawa K, Sugiyami K, Matsuyama H, et al. Mesalazine-induced eosinophilic pneumonia. Respiration 1999; 66: 69–72.
- 20 Bitton A, Peppercorn MA, Hanrahan JP. Mesalamine-induced lung toxicity. Am J Gastroenterol 1996; 91: 1039.
- 21 Lazaro MT, Garcia-Tejero MT, Diaz-Lobato S. Mesalamine-induced lung disease. Arch Intern Med 1997; 157: 462.
- 22 Saltzman K, Rossoff LJ, Gouda H, et al. Mesalamine-induced unilateral eosinophilic pneumonia. AJR 2001; 177: 257.
- 23 Cooper JAD, White DA, Matthay RA. Drug-induced pulmonary disease: noncytotoxic drugs. Am J Respir Crit Care Med 1986; 133: 488.
- 24 Sesin GP, Mucciardi N, Almeida S. Mesalamine-associated pleural effusion with pulmonary infiltration. Am J Health Syst Pharm 1998; 55: 2304–5.
- 25 Reyes CN, Wenzel FJ, Lawton BR, et al. The pulmonary pathology of farmer's lung disease. Chest 1982; 81: 142–6.
- 26 Burke GW, Carrington CB, Strauss R, et al. Allergic alveolitis caused by home humidifiers: unusual clinical features and electron microscopic findings. JAMA 1977; 238: 2705–8.
- 27 Kawanami O, Basset F, Barrios R, et al. Hypersensitivity pneumonitis in man. Am J Pathol 1983; 110: 275–89.
- 28 Gonzalez-Rothi RJ, Zander DS, Ros PR. Fluoxetine hydrochloride (Prozac)-induced pulmonary disease. Chest 1995; 107: 1763–5.
- 29 Sostman HD, Matthay RA, Putman CE, et al. Methotrexate-induced pneumonitis. Medicine (Baltimore) 1976; 55: 371–88.
- 30 Manicardi V, Bernini G, Bossini P, et al. Low-dose amiodarone-induced pneumonitis: evidence of an immunologic pathogenetic mechanism. Am J Med 1989; 86: 134–5.
- 31 Myers JL, Kennedy JI, Plumb VJ. Amiodarone lung: pathologic findings in clinically toxic patients. Hum Pathol 1987; 18: 349–54.
- 32 Nilubol N, Taub PJ, Venturero M, et al. Ulcerative colitis and sarcoidosis. Mt Sinai J Med 2001; 68: 400–2.
- 33 Cox NH, McCrea JD. A case of Sjogren's syndrome, sarcoidosis, previous ulcerative colitis and gastric autoantibodies. Br J Dermatol 1996; 134: 1138–40.
- 34 Fries W, Grassi SA, Leone L, et al. Association between inflammatory bowel disease and sarcoidosis: report of two cases and review of the literature. Scand J Gastroenterol 1995; 30: 1221–3.
- 35 Johnson CD. Obstructive jaundice in a patient with ulcerative colitis, Sjogren's syndrome and sarcoidosis. J R Soc Med 1989; 82: 362.
- 36 Barr GD, Shale DJ, Jewell DP. Ulcerative colitis and sarcoidosis. Postgrad Med J 1986; 62: 341–5.
- 37 Theodoropoulos G, Archimandritis A, Davaris P, et al. Ulcerative colitis and sarcoidosis: a curious association—report of a case. Dis Colon Rectum 1981; 24: 308–10.
- 38 Le Gros V, Saveuse H, Lesur G. Lung and skin hypersensitivity to 5-aminosalicylic acid. Br Med J 1991; 1: 970.
