Volume 68 Number 6 November 2001	back to contents

Bronchiolitis Obliterans in a Patient with Ulcerative Colitis Receiving Mesalamine	384-388
George Haralambou, M.D.1, Alvin S. Teirstein, M.D.1, Joan Gil, M.D.2, and Daniel H. Present, M.D.3
1Division of Pulmonary and Critical Care Medicine, 2Department of Pathology, and 3Division of Gastroenterology, Mount Sinai School of Medicine, New York, NY. Address correspondence to Alvin S. Teirstein, M.D., One East 100th Street, Box 1232, New York, NY 10029. Supported by the Catherine and Henry J. Gaisman Foundation.

ABSTRACT
An 18-year-old woman with ulcerative colitis (UC) developed diffuse pulmonary infiltrates and hypoxemia three months after reinstitution of oral mesalamine. Lung biopsy revealed bronchiolitis obliterans with interstitial pneumonitis. Clinical and radiographic abnormalities improved upon discontinuation of mesalamine and treatment with corticosteroids. This patient presented the problem of differential diagnosis of pulmonary disease associated with inflammatory bowel disease (IBD), including lesions believed to result from lung involvement secondary to IBD, as well as adverse reactions to medications. We present and analyze evidence associating mesalamine with pulmonary toxicity in this patient, but emphasize that the distinction between adverse drug reaction and extraintestinal manifestations of IBD is difficult.

KEY WORDS
Bronchiolitis obliterans, ulcerative colitis, mesalamine.

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