Wada Shoya, Kumagai Hideki, Yokoyama Koji, Ito Takane, Miyauchi Akihiko, Sakamoto Saori, Imagawa Tomoyuki, Tulyeu Janyerkye, Tanaka Masanori, Yamagata Takanori
Department of Pediatrics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
Department of Pathology and Laboratory Medicine, Hirosaki City Hospital, Hirosaki, Aomori, Japan.
Clin J Gastroenterol. 2016 Oct;9(5):302-5. doi: 10.1007/s12328-016-0675-2. Epub 2016 Aug 8.
5-Aminosalicylic acid preparations have been used as first-line drugs for treatment of ulcerative colitis (UC). However, some patients with UC present with exacerbation of symptoms because of allergy to mesalazine. Diagnosis of mesalazine allergy in active UC may be challenging because its symptoms mimic those of UC. Here we describe a 13-year-old boy with mesalazine allergy who achieved remission when his medication was changed from mesalazine to salazosulfapyridine. During his clinical course mesalazine was prescribed twice, and on each occasion exacerbation of the symptoms occurred. We considered a diagnosis of mesalazine allergy, and this was confirmed by a drug lymphocyte stimulation test; the result for salazosulfapyridine was negative. On the basis of criteria involving simple mucosal biopsy combined with endoscopy for predicting patients with UC who would ultimately require surgery, we considered that the UC in this case might be susceptible to steroid treatment, and we therefore treated the patient with salazosulfapyridine and prednisolone. Shortly afterwards, remission was achieved and the patient has remained in good condition on salazosulfapyridine alone. When treating patients with mesalazine, the possibility of allergy should always be borne in mind, especially when the clinical course is inconsistent with the results of biopsy.
5-氨基水杨酸制剂一直被用作治疗溃疡性结肠炎（UC）的一线药物。然而，一些UC患者因对美沙拉嗪过敏而出现症状加重。在活动性UC中诊断美沙拉嗪过敏可能具有挑战性，因为其症状与UC相似。在此，我们描述一名13岁对美沙拉嗪过敏的男孩，当他的药物从美沙拉嗪换成柳氮磺吡啶后病情缓解。在他的临床过程中，曾两次使用美沙拉嗪，每次均出现症状加重。我们考虑诊断为美沙拉嗪过敏，并通过药物淋巴细胞刺激试验得以证实；柳氮磺吡啶的试验结果为阴性。基于涉及简单黏膜活检联合内镜检查以预测最终需要手术的UC患者的标准，我们认为该病例中的UC可能对类固醇治疗敏感，因此我们用柳氮磺吡啶和泼尼松龙对患者进行治疗。不久后病情缓解，患者仅使用柳氮磺吡啶就一直保持良好状态。在治疗使用美沙拉嗪的患者时，应始终牢记过敏的可能性，尤其是当临床过程与活检结果不一致时。
