title: Mesalamine Intolerance in Three Children with Crohn's Disease.
abstract: OBJECTIVE
  To present the mesalamine-induced acute exacerbation of symptoms and inflammatory markers in children with Crohn's disease (CD).
  
  
  METHODS
  Three children who presented with CD had acute exacerbation of colitis symptoms or elevated inflammatory markers when mesalamine was added to treatment while tapering/ceasing steroid treatment. While on steroid treatment, the patients maintained clinical and laboratory remission, but with the initiation of mesalamine treatment, they had abdominal pain and bloody mucoid diarrhoea and/or elevation of white blood cell count, C-reactive protein level and erythrocyte sedimentation rate. Bacterial pathogens were excluded from the urine, throat and blood cultures, parasites with stool examination, viral pathogens with serology. Within 3-7 days after the mesalamine treatment had been stopped, the patients showed improvement of colitis symptoms and normalisation of white blood cell count, C-reactive protein level and erythrocyte sedimentation rate.
  
  
  CONCLUSIONS
  In this study mesalamine mimicked CD relapse in children with CD while tapering or after stopping steroid treatment. Awareness of this side effect of mesalamine could prevent a misdiagnosis of steroid dependency.
authors.affiliation: Division of Gastroenterology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey.
authors.forename: Ceyda
authors.initials: C
authors.lastname: Tuna Kirsaclioglu
authors.forename: Zarife
authors.initials: Z
authors.lastname: Kuloglu
authors.forename: Gonca
authors.initials: G
authors.lastname: Ustundag
authors.forename: Aydan
authors.initials: A
authors.lastname: Kansu
authors.forename: Erdal
authors.initials: E
authors.lastname: İnce
authors.forename: Arzu
authors.initials: A
authors.lastname: Ensari
authors.forename: Nurten
authors.initials: N
authors.lastname: Girgin
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use; D002097:C-Reactive Protein / Q000032:analysis; D002648:Child; D003424:Crohn Disease / Q000188:drug therapy* / Q000276:immunology*; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D019804:Mesalamine / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D018836:Inflammation Mediators; D019804:Mesalamine; D002097:C-Reactive Protein