Acute eosinophilic pneumonia related to a mesalazine suppository
A 30-year-old woman presented with cough that was aggravated at night for 10 days. She had ulcerative colitis and had undergone a left hemi-colectomy with a colostomy 7 weeks ago. She had received a mesalazine suppository (1 g/day) for 19 days after the operation. At the time of presentation, the patient complained of fatigue, general weakness, myalgia, cough, and a small amount of non-purulent sputum. A chest X-ray and high resolution computed tomography showed peripheral patchy consolidations with interlobular septal thickening in both lungs. Blood eosinophils were 24.5%, level of total IgE was 169 KU/L and specific IgE for dust mites were 3+ in UniCAP system. Total cell count was 31.5 × 105 cell/mL with 73.2% macrophages, 19.6% neutrophils, 1.6% eosinophils, 0% lymphocytes in bronchoalveolar lavage fluid. Tests for nine respiratory associated viruses (adenovirus; Rous sarcoma virus; rhinovirus; metapneumovirus; seasonal influenza A and B; parainfluenza virus 1, 2, and 3; and novel H1N1 virus) were all negative by real-time PCR. Test results for antinuclear antibodies, rheumatoid factor, anti-ds DNA antibody, and antineutrophil cytoplasmic antibody were negative. The lung biopsy demonstrated that a patchy interstitial and intra-alveolar histiocytic infiltration was admixed with many eosinophils and some neutrophils and foci of organizing fibrosis, suggestive of eosinophilic pneumonia and BOOP (). The mesalazine suppository was stopped. She was treated with 500 mg methylprednisolone intravenously for 3 days followed by 30 mg prednisolone orally. She recovered completely.