Cilloniz Rafael, Chesrown Sarah Elizabeth, Gonzalez-Peralta Regino P
University of Florida, Pediatrics, 1600 SW Archer Rd, PO Box 100296, Gainesville, Florida, 32610, USA.
BMJ Case Rep. 2009;2009. doi: 10.1136/bcr.09.2008.0908. Epub 2009 Mar 20.
The present report describes the case of a 14-year-old boy receiving mesalamine for Crohn disease who was discovered to have incidental pulmonary infiltrates on chest radiograph and CT scan shortly after increasing the dose of this medication. Despite the significant radiographic abnormalities, he had no respiratory symptoms. He had normal oxygenation and normal pulmonary function tests including spirometry, lung volumes and diffusion capacity. Transbronchial biopsies showed patchy interstitial fibrosis with ill-defined non-necrotising granulomas and lymphoid aggregates. Pulmonary infiltrates resolved within 6 weeks of discontinuation of mesalamine and the addition of low-dose daily corticosteroids. This case likely represents an asymptomatic "early stage" of mesalamine-induced lung injury preceding the onset of symptoms. Alternatively, mesalamine may induce asymptomatic lung injury more commonly than is presently suspected. To the best of our knowledge this is the first time this complication has been reported without respiratory symptoms.
本报告描述了一名14岁克罗恩病男孩的病例，该男孩在增加美沙拉嗪剂量后不久，胸部X光片和CT扫描发现有偶然的肺部浸润。尽管影像学上有明显异常，但他没有呼吸道症状。他的氧合正常，肺功能测试（包括肺活量测定、肺容积和弥散功能）也正常。经支气管活检显示有斑片状间质纤维化，伴有边界不清的非坏死性肉芽肿和淋巴样聚集。在停用美沙拉嗪并加用低剂量每日糖皮质激素后，肺部浸润在6周内消退。该病例可能代表了美沙拉嗪诱导的肺损伤在症状出现之前的无症状“早期”。或者，美沙拉嗪可能比目前怀疑的更常引起无症状肺损伤。据我们所知，这是首次报道这种无呼吸道症状的并发症。
