RESUMEN
Mesalazine is the most widely used aminosalicylate for induction and maintenance of remission in patients with mild-to-moderate ulcerative colitis (UC). Drug-induced hypersensitivity pneumonitis is considered very rare (<1/10.000 patients). Due to its rarity and the scarce cases reported, mesalazine-induced lung injury needs to be highly suspected in a patient with onset of respiratory symptoms and UC under treatment with salicylates. It should make the clinician formulate a differential diagnosis that includes not only infections (tuberculosis, bacterial...) or the inflammatory bowel disease itself, but also the current coronavirus disease 2019 (COVID-19) since their clinical and radiological manifestations may be very similar.
Asunto(s)
COVID-19 , Colitis Ulcerosa , Enfermedades Pulmonares Intersticiales , Antiinflamatorios no Esteroideos/efectos adversos , Colitis Ulcerosa/tratamiento farmacológico , Humanos , Enfermedades Pulmonares Intersticiales/inducido químicamente , Enfermedades Pulmonares Intersticiales/diagnóstico por imagen , Enfermedades Pulmonares Intersticiales/tratamiento farmacológico , Mesalamina/efectos adversosRESUMEN
A 53-year-old female with a history of HLA-B27 positive polyarthritis underwent a splenectomy due to an incidental splenic lesion, which was confirmed as an inflammatory pseudotumor (IPT). Afterwards, two liver lesions were found and histopathological examination revealed inflammatory pseudotumor-like follicular dendritic cell sarcoma (IPT-like FDCS). The patient received NSAIDs, corticosteroids, antibiotics and azathioprine, with no response. Within the next few months, there was an abrupt clinical worsening due to rapid progression of the hepatic lesions and a massive hepatomegaly. New biopsies were obtained, showing undifferentiated sarcoma. The patient started chemotherapy with doxorubicin and eventually died.