Sulfasalazine pulmonary toxicity in ulcerative colitis mimicking clinical features of Wegener's granulomatosis.
The centrally accentuated antineutrophil cytoplasmic antibody test (c-ANCA) is widely regarded as a sensitive and specific marker for Wegener's granulomatosis (WG). There are increasing reports, however, of false-positive c-ANCAs, usually in the setting of other vasculidities. We report a case of a 27-year-old man with ulcerative colitis who developed pulmonary symptoms, peripheral nodular lung infiltrates, and an elevated c-ANCA suggesting WG. Chest CT and open lung biopsy specimens were consistent with WG. The symptoms and pulmonary infiltrates resolved after discontinuation of sulfasalazine therapy. The c-ANCA remained elevated due to the occurrence of false-positive values in ulcerative colitis. We conclude sulfasalazine toxicity can mimic clinical aspects of WG and that c-ANCA testing should be interpreted with caution in patients with ulcerative colitis.
Salerno
S M
SM
Department of Medicine, Madigan Army Medical Center, Tacoma, Wash 98431-5000, USA.
Ormseth
E J
EJ
Roth
B J
BJ
Meyer
C A
CA
Christensen
E D
ED
Dillard
T A
TA
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000009:adverse effects* / Q000627:therapeutic use; D019268:Antibodies, Antineutrophil Cytoplasmic; D001323:Autoantibodies / Q000032:analysis; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000276:immunology; D003937:Diagnosis, Differential; D005189:False Positive Reactions; D014890:Granulomatosis with Polyangiitis / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000187:drug effects*; D008171:Lung Diseases / Q000139:chemically induced / Q000175:diagnosis; D008297:Male; D011859:Radiography; D012460:Sulfasalazine / Q000009:adverse effects* / Q000627:therapeutic use
D000893:Anti-Inflammatory Agents; D019268:Antibodies, Antineutrophil Cytoplasmic; D001323:Autoantibodies; D012460:Sulfasalazine