Huang Po-Han, Kuo Chia-Jung, Lin Chang-Wei, Cheng Yu-Ming, Hu Han-Chung, Lin Chun-Yen, Su Ming-Yao, Chiu Cheng-Tang
Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital.
Chang Gung University, College of Medicine.
Medicine (Baltimore). 2018 Nov;97(48):e13242. doi: 10.1097/MD.0000000000013242.
Mesalazine is widely used to treat inflammatory bowel disease (IBD). However, discriminating between pulmonary manifestations of IBD and drug-related lung disease remains a challenge. There were few case reports of mesalazine-related organizing pneumonia so far.
A 75-year-old female was diagnosed with ulcerative colitis and took mesalazine over a period of 2 years and 8 months. She presented with progressive shortness of breath for 3 days and visited our emergency department. Chest radiography showed increased bilateral infiltrates. During hospitalization her clinical condition deteriorated, and she was transferred to our intensive care unit under noninvasive ventilator support.
Computed tomography (CT) scan showed diffuse peribronchial and subpleural consolidations in bilateral lungs. Possible etiologies of interstitial lung disease were surveyed, including various infectious diseases and connective tissue diseases. Transbronchial lung biopsy showed characteristic features of organizing pneumonia.
Under the consideration of mesalazine-related lung disease, mesalazine was discontinued early in disease course and steroid therapy was given.
The patient was discharged from hospital with improved clinical symptoms and radiographic images.
Although this patient suffered a life-threatening adverse event, prompt diagnosis with proper management can result in a favorable outcome.
美沙拉嗪广泛用于治疗炎症性肠病（IBD）。然而，区分IBD的肺部表现和药物相关的肺部疾病仍然是一项挑战。到目前为止，美沙拉嗪相关的机化性肺炎病例报告很少。
一名75岁女性被诊断为溃疡性结肠炎，服用美沙拉嗪2年8个月。她出现进行性气短3天，就诊于我院急诊科。胸部X线检查显示双侧浸润影增多。住院期间她的临床状况恶化，在无创通气支持下被转入我院重症监护病房。
计算机断层扫描（CT）显示双肺弥漫性支气管周围和胸膜下实变。对间质性肺疾病的可能病因进行了调查，包括各种传染病和结缔组织病。经支气管肺活检显示机化性肺炎的特征性表现。
考虑到美沙拉嗪相关的肺部疾病，在病程早期停用美沙拉嗪并给予类固醇治疗。
患者临床症状和影像学表现改善后出院。
尽管该患者发生了危及生命的不良事件，但及时诊断并采取适当的治疗措施可取得良好的结果。
