Internal Medicine of the Elderly, Geneva University Hospitals, Geneva, Switzerland
Internal Medicine of the Elderly, Geneva University Hospitals, Geneva, Switzerland.
BMJ Case Rep. 2022 Feb 25;15(2):e248229. doi: 10.1136/bcr-2021-248229.
Mesalazine is often used as first-line therapy for ulcerative colitis. Several reports have pointed to systemic adverse reactions associated with this drug. Most have evoked a drug-induced hypersensitivity syndrome, while some have described lupus syndromes but with limited clinical and varied biological features. A 75-year-old man presented with fever, dyspnoea, chest pain, polyarthralgia, and myalgia, following mesalazine introduction. Clinical symptoms and low-titre positive antihistone antibodies disappeared after mesalazine withdrawal without recourse to steroids. Pericardial effusion and 8F-fluorodeoxyglucose uptake on positron emission tomography/CT scan, and glomerular haematuria and proteinuria also disappeared. Cytokine-lymphocyte transformation tests showed a strong sensitisation pattern with interleukin-5 production. This case advances our knowledge of the mechanism of mesalazine-induced adverse effects, namely via drug-induced hypersensitivity with lupus manifestations, which we are the first to report.
美沙拉嗪常用于溃疡性结肠炎的一线治疗。有几项报告指出与该药物相关的全身不良反应。大多数情况下会引发药物诱导的超敏反应综合征，而有些情况则描述了狼疮综合征，但临床表现有限且生物学特征各异。一位 75 岁男性在使用美沙拉嗪后出现发热、呼吸困难、胸痛、多发性关节炎和肌痛。停用美沙拉嗪后，临床症状和低滴度抗组蛋白抗体消失，无需使用类固醇。经正电子发射断层扫描/CT 扫描发现心包积液和 8F-氟脱氧葡萄糖摄取，以及肾小球性血尿和蛋白尿也消失。细胞因子-淋巴细胞转化试验显示具有较强的致敏模式，伴有白细胞介素-5 的产生。该病例增加了我们对美沙拉嗪诱导的不良反应机制的认识，即通过药物诱导的超敏反应伴狼疮表现，这是我们首次报道。
