Pneumotox » Drug » Mesalazine-Mesalamine-5-aminosalicylic acid-5-ASA

Mesalazine-Mesalamine-5-aminosalicylic acid-5-ASA

4

Mesalazine, mesalasine or 5-aminosalicylate. Several patterns or respiratory involvement caused by this drug can also be observed in the course of untreated inflammatory bowel disease UC and CD. Causality in cases with exposure to mesalazine and anti-TNF agents can be difficult to disentangle (PMID: 23983443). Drug-induced involvement in IBD is against the specific respiratory and cardiovasculare manifestations of the IBD UC and CD (PMID: 22958334)

Last update : 30/01/2022

I.a Pneumonitis (ILD), acute and/or severe (may cause ARDS)

1

I.b Pneumonitis (ILD)

1

I.c Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia)

2

I.d Organizing pneumonia pattern (an area or areas of consolidation on imaging)

1

I.e Acute eosinophilic pneumonia (AEP)

1

I.m ILD with a granulomatous component

1

II.d Pulmonary edema, cardiogenic

1

IV.c Obliterative bronchiolitis (a pattern consistent with) (see also IVn, XVx)

1

IV.j Bronchiolitis (a clinical-imaging pattern suggestive of)

1

IV.k Bronchiectasis

1

IV.ad Large airway inflammation - Tracheitis (w/wo tissue eosinophilia)

1

V.a Pleural effusion (uni- or bilateral) (can accompany DI-LDs)

1

V.b Eosinophilic pleural effusion

1

V.m Pleuropericarditis - Pleuropericardial effusion (ANA unknown or negative)

1

X.a DRES syndrome - DRESS-like reaction

1

X.d Lupus - Lupus syndrome (see also Vd)

1

XI.b Chest pain (acute or subacute), lone or prominent

1

XII.a Left or biventricular dysfunction/failure

1

XII.c Pericardial effusion (w/wo tamponade)

1

XII.d Myocarditis (can be fulminant)

1

XII.g Coronary artery disease (acute) - Myocardial ischemia/infarction

-

XII.h Eosinophilic myocarditis

1

XII.n Cardiovascular collapse - Cardiogenic shock - Hypotension

1

XII.q Pericarditis (see also under XIIc)

1

XII.bf Myopericarditis (see under XIIc/d/g)

1

XV.a Path: NSIP-cellular pattern (see also Ia, Ib)

1

XV.b Path: Eosinophilic pneumonia (subacute or acute) (see also Ic)

1

XV.c Path: Organizing pneumonia (OP/BOOP) pattern (see also Id)

2

XV.e Path: ILD with a granulomatous component (see also Im)

1

XV.z Path: Obliterative (constrictive) bronchiolitis (see also IVc, IVn)

1

XVI.b Imaging: Ground-glass opacities (GGO) / shadowing

1

XVI.k Imaging: An area or areas of consolidation

3

XVI.ay Imaging: Asymmetrical, predominantly unilateral involvement

1

XIX.a BAL: An excess proportion of lymphocytes

1

XIX.c BAL: An excess proportion of eosinophils

1

Diagnosing DIRD

1

Drug and radiation history

2

Drug singularity - Correct identification of the drug

3

Consistent timing of exposure v. onset of symptoms

4

Clinical, imaging, BAL, pathological pattern consistent with the specific drug

5

Careful exlusion of another cause

6

Remission of symptoms with removal of drug

7

Recurrence with rechallenge (rarely advisable)

8

Causality assessment

More detailed checklist