Chest
Volume 81, Issue 6, June 1982, Pages 766-768
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Selected Reports
Fibrosing Alveolitis, Bronchiolitis Obliterans, and Sulfasalazine Therapy

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A patient with ulcerative colitis had extensive upper zone pulmonary disease while taking sulfasalazine. Pulmonary function tests showed progressive restrictive and obstructive disease. Lung biopsy showed bronchiolitis obliterans and chronic interstitial pneumonia or fibrosing alveolitis with a mild eosinophilic infiltrate. The patient improved after receiving steroid therapy. A review of the literature of lung disease related to ulcerative colitis and sulfasalazine is presented.

Section snippets

CASE REPORT

A 66-year-old male exsmoker had a diagnosis of ulcerative colitis and was given sulfasalazine, 8 g/day, and hydrocortisone enemas. His initial chest roentgenogram was normal. With symptomatic improvement, the sulfasalazine dosage was reduced to 2 g/day. Shortness of breath on exertion was first noted six months after initiation of treatment. Four months later, a fever with a dry cough developed, but he had no other symptoms suggestive of a viral illness. Sulfasalazine therapy was discontinued.

COMMENTS

To our knowledge, there have been eight reported cases of sulfasalazine-related lung disease.2, 3, 4, 5, 6, 7, 8, 9, 10 The daily dosage of sulfasalazine ranged from 1.5 to 6.0 g, and the length of exposure from 1.5 to 7.0 months. Symptoms described included dyspnea,2, 3, 4, 5, 6, 7, 8, 9, 10 fever,3, 4, 7, 8, 9Table 1—Pulmonary Function Tests cough,3, 4, 7 and wheeze.2 Pulmonary syndromes described were tracheal edema,2 pulmonary eosinophilia,3, 7, 8, 9 pulmonary infiltrates,4 and fibrosing

ACKNOWLEDGMENT

Our thanks to Dr. D. Chamberlain, Toronto General Hospital, for his most helpful comments on the pathology of this case.

REFERENCES (16)

  • KA Constantinidis

    Eosinophilic pneumonia: an unusual side effect of therapy with salicylazosulfapyridine

    Chest

    (1976)
  • EC Rosenow

    The spectrum of drug-induced pulmonary disease

    Ann Intern Med

    (1972)
  • JR Collins

    Adverse reactions to salicylazosulphapyridine (Azulfidine) in the treatment of ulcerative colitis

    South Med J

    (1968)
  • GR Jones et al.

    Sulphasalazine induced lung disease

    Thorax

    (1972)
  • P Thomas et al.

    Respiratory disease due to Sulphasalazine

    Clin Allergy

    (1974)
  • Editorial

    Sulphasalazine-induced lung disease

    Lancet

    (1974)
  • D Davies et al.

    Fibrosing alveolitis and treatment with sulphasalazine

    Gut

    (1974)
  • TF Tydd et al.

    Sulphasalazine lung

    Med J Aust

    (1976)
There are more references available in the full text version of this article.

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