Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0032285 (pneumonia)
 54,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

6-mercaptopurine (6-MP) and azathioprine are important drugs for the treatment of inflammatory bowel disease (IBD) but their actions suppress host defense against infection. A challenging case of a 19-year-old female patient with quiescent Crohn's disease maintained with 6-MP presenting with dyspnea and a normal chest exam and x-ray is presented. She became ventilator-dependent and only after numerous investigations was diagnosed with cytomegalovirus (CMV) pneumonitis. A systematic literature review of CMV infections in IBD patients was performed. The present case is the first report of a patient with quiescent IBD maintained on 6-MP who developed CMV pneumonitis. Other reports have identified patients with active disease on multiple immunosuppressants who developed CMV pneumonitis and also highlight the risk of CMV colitis in refractory IBD. The authors review the approach to the diagnosis of CMV infections in IBD patients with atypical pneumonia and colitis and highlight the importance of considering CMV infection in these settings.
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PMID:6-mercaptopurine and inflammatory bowel disease: hidden ground for the cytomegalovirus. 1277 6

Inflammatory bowel disease is a systemic illness that may involve the lung. The most frequent manifestation is bronchial inflammation and suppuration with or without bronchiectasis. Bronchoalveolar lavage data show an increase percentage of neutrophils and steroids are very effective in the majority of cases. Some patients present severe tracheal inflammation and obstruction with an inflammatory mass bulging into the tracheal lumen. Others show a small airway involvement with or without bronchiolitis obliterans organizing pneumonia pattern and have an equivocal response to steroids. In recent years many investigators demonstrated latent pulmonary involvement with a reduction in lung transfer factor and a small airways disorders.
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PMID:Pulmonary involvement in inflammatory bowel disease. 1558 91

Two years after being diagnosed with ulcerative colitis, a 57-year-old man taking oral mesalamine experienced severe respiratory distress due to left lung pleuropneumonitis. Eight months later, severe respiratory distress recurred due to right lung pneumonitis. Extraintestinal manifestations of inflammatory bowel disease or mesalamine-induced pulmonary injury were considered in the differential diagnosis, which was complicated by a history of aseptic meningitis and evidence of an ongoing autoimmune response. The implications of the case are discussed.
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PMID:Mesalamine-induced lung injury in a patient with ulcerative colitis and a confounding autoimmune background: a case report. 1577 Mar 45

Inhibitors of tumor necrosis factor-alpha (TNF-alpha) have been approved for treating rheumatoid arthritis. As one of the biological response modifiers, etanercept has also been used in the treatment of psoriatic arthritis and inflammatory bowel disease. While etanercept is effective, certain infectious complications, such as tuberculosis, fungus, and cytomegalovirus, have been reported. We report the first Korean case of adenoviral pneumonia in a 55-year-old female who developed disseminated adenoviral infection following etanercept treatment, which resolved after anti-TNF-alpha discontinuation.
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PMID:Adenoviral pneumonia during etanercept treatment in a patient with rheumatoid arthritis. 1742 51

Azathioprine and 6-mercaptopurine (6-MP) are effective in inflammatory bowel disease (IBD). However, between 10% and 29% of patients treated with these drugs are forced to stop therapy due to side effects. Pulmonary toxicity due to azathioprine/6-MP has been reported infrequently. We describe 3 patients who developed severe, noninfectious pulmonary toxicity within 1 month after the initiation of azathioprine or 6-MP for the treatment of IBD colitis (2 Crohn's disease and 1 ulcerative colitis). All patients presented with dyspnea, cough, and fever after initiation of azathioprine/6-MP. Evaluation for infectious etiologies, including bronchoscopy (3/3 patients) and open-lung biopsy (2/3 patients) was negative. Histopathologic examination of the lung biopsies revealed bronchiolitis obliterans organizing pneumonia in one, and usual interstitial pneumonitis in another patient. Cessation of purine analog therapy resulted in clinical improvement in all 3 cases. Azathioprine/6-MP-related pulmonary toxicity is a rare but serious side effect, and it is important for clinicians to have a high index of suspicion for this adverse reaction which occurs within 1 month after initiation of treatment for IBD.
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PMID:Severe pulmonary toxicity after azathioprine/6-mercaptopurine initiation for the treatment of inflammatory bowel disease. 1766 53

We report a case of an 18-yr-old male with high-grade persistent fever, productive cough, malaise, diarrhea and associated abnormal findings on chest radiography. The patient suffered from ulcerative colitis receiving mesalazine and azathioprine. After a further and scrutinized work-up the diagnosis of drug-induced pulmonary toxicity was made. His condition was improved after discontinuing both drugs and the administration of corticosteroids. This is a rarely reported case of eosinophilic pneumonia. Although it has not been reported previously, the possibility of mesalazine and azathioprine synergism cannot be excluded. The clinical, aetiological, diagnostic and therapeutic aspects of the disease are discussed demonstrating the paramount importance of bronchoalveolar lavage in the diagnosis of this disorder. One should be aware of this entity in patients with inflammatory bowel disease.
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PMID:Drug-induced pulmonary toxicity in a patient treated with mesalazine and azathioprine for ulcerative colitis. 1807 39

Extraintestinal respiratory manifestations in inflammatory bowel disease (IBD) are rare. We present a case of bronchiolitis obliterans organizing pneumonia (BOOP) in a patient with Crohn s disease, with clinical remission with no drug therapy.
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PMID:[Bronchiolitis obliterans organizing pneumonia and Crohn's disease]. 1841 45

Six 3-month-old BALB/c Rag2-/- mice developed dyspnea 10 days after intravenous injection of wild type BALB/c CD45RB(high) lymphocytes to induce colitis as a model of inflammatory bowel disease. The lungs of all 6 mice were diffusely gray-purple and did not collapse completely. Microscopic findings were extensive coalescent patchy to diffuse alveolitis, characterized by macrophages and multinucleate giant cells, lymphocytes in alveolar lumina and septa, alveolar luminal of neutrophils, and alveolar proteinic material containing small black vesicular bodies characteristic of Pneumocystis sp. in methenamine silver stained sections. The morphologic diagnosis was diffuse granulomatous pneumonia with intra-alveolar organisms consistent with Pneumocystis sp., with an unusually aggressive inflammatory response related to the experimental procedure and possibly to the BALB/c genetic background.
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PMID:Pneumonia in BALB/c Rag2-/- mice used in a CD45RB(high) T-cell transfer model of inflammatory bowel disease. 1848 6

There is an increased risk of developing bone marrow depression and infections during azathioprine therapy for inflammatory bowel disease. Patients with low or absent thiopurine S-methyltransferase (TPMT) activity have an increased risk of developing myelotoxicity. We describe a patient who developed pancytopenia combined with cytomegalovirus pneumonia after several years of azathioprine use. The bone marrow depression was probably caused by the viral infection, as all others causative factors were unlikely. Surprisingly, we observed grossly elevated TPMT activity (182 nmol/g/h) during the recovery phase, following the pancytopenic period. After complete recovery of the bone marrow suppression, TPMT activity returned to usual reference activity (43 nmol/g/h). This remarkable change in enzymatic activity of TPMT may be explained by differences in the age of red blood cells, as younger erythrocytes have a higher TPMT activity. Determination of a patient's TPMT status by phenotyping should therefore not be performed just after bone marrow depression or in cases of activated erythropoieses.
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PMID:Paradoxical elevated thiopurine S-methyltransferase activity after pancytopenia during azathioprine therapy: potential influence of red blood cell age. 1852 Jun 12

Mesalazine (5-aminosalicylic acid) and sulfasalazine are widely used in the treatment of inflammatory bowel disease. The pulmonary toxicity related to sulfasalazine was well-recognized complication and it was caused by sulfapyridine moiety in sulfasalazine. However, the lung injury related to mesalazine has rarely been reported. A thirty five-year-old man with Crohn's disease who was treated with mesalazine complained fever and dry cough. The finding of bilateral wandering pulmonary infiltration, peripheral eosinophilia and increased eosinophils in bronchoalveolar lavage were consistent with eosinophilic pneumonia. His symptoms and laboratory findings were markedly improved after the discontinuation of mesalazine. The mesalazine-induced eosinophilic pneumonia was diagnosed according to his clinical course. This report shows that the eosinophilic pneumonia should be considered in patients who develop pulmonary involvement with inflammatory bowel disease receiving mesalazine therapy.
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PMID:[Mesalazine-induced eosinophilic pneumonia in a patient with Crohn's disease]. 1923 38


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