title: Sulfasalazine pulmonary toxicity in ulcerative colitis mimicking clinical features of Wegener's granulomatosis.
abstract: 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.
authors.affiliation: Department of Medicine, Madigan Army Medical Center, Tacoma, Wash 98431-5000, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Salerno
authors.forename: E J
authors.initials: EJ
authors.lastname: Ormseth
authors.forename: B J
authors.initials: BJ
authors.lastname: Roth
authors.forename: C A
authors.initials: CA
authors.lastname: Meyer
authors.forename: E D
authors.initials: ED
authors.lastname: Christensen
authors.forename: T A
authors.initials: TA
authors.lastname: Dillard
mesh_terms: 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
chemical_list: D000893:Anti-Inflammatory Agents; D019268:Antibodies, Antineutrophil Cytoplasmic; D001323:Autoantibodies; D012460:Sulfasalazine