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Case Reports: Adverse drug reactions and complications
Drug-induced hypersensitivity syndrome with lupus manifestations due to mesalazine in a patient with ulcerative colitis
  1. Omar Zgheib1,
  2. Véronique Trombert1,
  3. Peter Jandus2 and
  4. Christine Serratrice1
  1. 1Internal Medicine of the Elderly, Geneva University Hospitals, Geneva, Switzerland
  2. 2Immunology and Allergology, Geneva University Hospitals, Geneva, Switzerland
  1. Correspondence to Dr Omar Zgheib; omar.zgheib{at}hcuge.ch

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.

  • gastrointestinal system
  • ulcerative colitis
  • unwanted effects / adverse reactions
  • immunology

https://doi.org/10.1136/bcr-2021-248229

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    Footnotes

    • Contributors OZ provided the initial hypothesis, and all authors contributed to formal analysis. OZ wrote the manuscript. VT, PJ and CS contributed to editing and reviewing the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.