[Organizing pneumonia during treatment with mesalazine].
BACKGROUND
The distinction between extra-intestinal manifestations of ulcerative colitis (UC) and drug-induced pneumonia can often be difficult.


METHODS
We describe the case of a 72-year-old male who presented fever and sub-acute respiratory insufficiency, after 4 months of treatment with mesalazine for ulcerative colitis (UC). Initial tests found serum C-reactive protein, eosinophil count and total IgE to be elevated. Routine bacteriological, fungal and mycobacterial cultures were negative. Bronchoalveolar lavage fluid cellularity was normal with elevated lymphocyte, neutrophil, and eosinophil counts (35 % mononuclear cells, 23 % lymphocytes, 28 % neutrophils, 14 % eosinophils). The diagnosis of organizing pneumonia (OP) with eosinophilic pneumonia component was confirmed after examination of a lung biopsy specimen. Clinical improvement occurred after cessation of mesalazine and initiation of prednisolone (1mg/kg/day). Nine months later, a recurrence of gastrointestinal symptoms required a 5 months reintroduction of an amino salicylate by topical therapy (4- acide aminosalicylique [ASA enemas]). There was no resurgence of the pneumonia.


CONCLUSIONS
Organizing pneumonia is a rare extra-intestinal manifestation of UC. There was no resurgence of OP after amino salicylate enemas rechallenge but mesalazine-induced pneumonia cannot be excluded.
Service de pneumologie, hôpitaux privés de Metz, 57000 Metz, France; Université Henri-Poincaré, 54000 Nancy, France. Electronic address: b.michy@live.fr.
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Michy
Service de pneumologie, hôpitaux privés de Metz, 57000 Metz, France.
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S
Raymond
Service de médecine interne et de maladies infectieuses et tropicales, hôpital d'instruction des Armées-Legouest, 57000 Metz, France.
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B
Graffin
D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D019804:Mesalamine / Q000627:therapeutic use*; D011014:Pneumonia / Q000139:chemically induced* / Q000150:complications / Q000175:diagnosis; D011350:Proctocolitis / Q000188:drug therapy*; D011657:Pulmonary Eosinophilia / Q000139:chemically induced* / Q000150:complications / Q000175:diagnosis
D000893:Anti-Inflammatory Agents; D019804:Mesalamine
Colitis ulcerative; Cryptogenic organizing pneumonia; Iatrogenic diseases; Iatrogénie; Interstitial pneumonia; Mesalamine; Mésalazine; Pneumopathie organisée cryptogénique; Pneumopathies interstitielles; Rectocolite ulcéro-hémorragique