Drug-induced hypersensitivity syndrome with lupus manifestations due to mesalazine in a patient with ulcerative colitis. Issue 2 (25th February 2022)

• Record Type: Journal Article
• Authors: Zgheib, Omar; Trombert, Véronique; Jandus, Peter; Serratrice, Christine
• Is Part Of: BMJ case reports. Volume 15:Issue 2(2022)
• Publication Date: 2022-02-25
• Subjects: gastrointestinal system -- ulcerative colitis -- unwanted effects / adverse reactions -- immunology; Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2021-248229
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : 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.