Volume 68 Number 6 November 2001	back to contents

Can a Drug-Induced Pulmonary Hypersensitivity Reaction Be Dose-Dependent? A Case with Mesalamine	389-395
Paolo Sossai, M.D.1, Maria G. Cappellato, M.D.1, and Stefano Stefani, M.D.2
From the 1Department of Medicine and Immunology Service, General Hospital, Feltre, Italy, and 2University of Health Sciences, The Chicago Medical School and Mount Sinai Medical Center, Chicago, IL. Address correspondence to Paolo Sossai, M.D., Via Antonio Bettio, 11, I-32100 Belluno, Italy.

ABSTRACT
Mesalamine-induced pulmonary adverse drug reactions (ADRs) in the course of therapy for inflammatory bowel diseases are rare events, having been reported in only 21 cases. This response, resembling hypersensitivity pneumonitis, is considered to be immunologically mediated and thus dose-independent. We report the case of a 70-year-old woman with ulcerative colitis (UC) who developed biopsy-proven interstitial pulmonary disease (lymphocytic alveolitis and mild interstitial pulmonary fibrosis) three months after starting mesalamine therapy.

The usual treatment in cases of ADR is cessation of the drug and initiation of corticosteroids. In this case, we continued the mesalamine therapy but halved the dose, and did not add corticosteroids. This approach led to a remission of the pulmonary manifestations without a resurgence of UC symptoms.

Based on a review of the literature and our own observation, we challenge the concept that mesalamine-induced pulmonary injury is always due to a hypersensitivity reaction. The evidence suggests that in some cases pulmonary ADR is dose-related; in such instances the most accepted therapy is not necessarily the most appropriate one.

KEY WORDS
Mesalamine, ulcerative colitis, adverse drug reaction, pulmonary manifestations, hypersensitivity reaction.

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