Shimodate Yuichi, Takanashi Kunihiro, Waga Eriko, Fujita Tomoki, Katsuki Shinichi, Nomura Masafumi
Department of Gastroenterology, Otaru Ekisaikai Hospital, Otaru, Japan.
Case Rep Gastroenterol. 2011 Apr 12;5(1):159-65. doi: 10.1159/000326931.
Mesalamine has been used as the first-line therapy for the treatment of ulcerative colitis (UC) because of its efficacy and fewer side effects. However, earlier study showed that mesalamine occasionally causes diarrhea. We are presenting a patient with active UC in whom bloody diarrhea accompanied by abdominal pain and fever occurred and the symptoms were aggravated after administration of mesalamine. In order to clarify the reason of symptoms aggravation, drug lymphocyte stimulation test and rechallenge trial with mesalamine were performed. The results indicated the possibility that aggravation was related to allergic reaction and was dose-dependent. Furthermore, we examined colonoscopic views but there was no remarkable change in before and after rechallenge trial. Based on the above result, the patient was diagnosed with mesalamine intolerance. In order to differentiate whether the exacerbation of bloody diarrhea is due to the side effects of the mesalamine or a true relapse of UC, taking careful history before and after increasing mesalamine dosage as well as being aware of side effects of mesalamine are required. Clinicians should be aware of diarrhea as a side effect of mesalamine particularly after onset of mesalamine formulation, change in mesalamine formulation, or change in mesalamine dose.
美沙拉嗪因其疗效和较少的副作用，已被用作治疗溃疡性结肠炎（UC）的一线疗法。然而，早期研究表明美沙拉嗪偶尔会引起腹泻。我们报告一例活动性UC患者，该患者出现血性腹泻并伴有腹痛和发热，在服用美沙拉嗪后症状加重。为了阐明症状加重的原因，进行了药物淋巴细胞刺激试验和美沙拉嗪再激发试验。结果表明症状加重可能与过敏反应有关，且呈剂量依赖性。此外，我们检查了结肠镜检查结果，但再激发试验前后没有明显变化。基于上述结果，该患者被诊断为美沙拉嗪不耐受。为了区分血性腹泻的加重是由于美沙拉嗪的副作用还是UC的真正复发，需要在增加美沙拉嗪剂量前后仔细询问病史，并了解美沙拉嗪的副作用。临床医生应特别注意腹泻是美沙拉嗪的副作用，尤其是在美沙拉嗪制剂开始使用后、美沙拉嗪制剂发生变化或美沙拉嗪剂量发生变化时。
