A Rare Cause of Interstitial Lung Disease in Rheumatology Clinic: Case Report for Sulfasalazine-Induced Acute Pulmonary Injury

Year 2020, Volume: 4 Issue: 3, 291 - 295, 29.10.2020

Sertaç Ketenci , Ender Salbaş , Mustafa Canbaz Faruk Özşahin

https://doi.org/10.30565/medalanya.714362

Abstract

Infection, primary lung pathology, rheumatic involvement, malignancy and drug-induced involvement can be suggested as differential diagnosis of a case with rheumatic disease who applied to an emergency service with pulmonary symptoms.The drugs cause 2.5-3% of interstitial lung diseases.Sulfasalazine has been widely used in the treatment of inflammatory rheumatic conditions and it is an extremely rare reason for interstitial lung disase. Here, we aimed to present the rarely seen sulfasalazine-induced interstitial pulmonary disease and its treatment. Sulphasalazine -induced lung disease can mimic the symptoms of infectious and rheumatic lung involvement and can cause serious diagnostic confusion.

Keywords

Sulphasalazine, Acute Pulmonary Injury, Interstitial Lung Disease, Ankylosing Spondylitis

Romatoloji Kliniğindeki Ender Bir İnterstisyel Akciğer Hastalığı Sebebi: Sulfasalazinin Tetiklediği Akut Akciğer Hasarı Olgusu

Abstract

Enfeksiyon , primer akciğer hastalıkları, romatolojik tutulum, malignite ve ilaca bağlı tutulumların hepsi interstisyel akciğer hastalığı bulgularıyla acil servise başvuran bir romatizma hastasında akla gelebilecek ayırıcı tanılardır. İlaçlara bağlı tutulumlar tüm interstisyel akciğer hastalığı olgularının %2.5 -3 arasındaki sebebini oluşturur. Sülfasalazin inflamatuar romatolojik hastalıkların tedavisinde geniş kullanım alanı olan bir ajan olup interstiyel akciğer hastalıklarına oldukça seyrek de olsa sebep olabilmektedir. Ayrıca sülfasalazine bağlı akciğer tutulumu enfeksiyonlar ve romatolojik tutulumları da taklit edip ciddi tanısal karışıklığa sebep olabilir. Biz de bu yazımızda ; nadiren karşılaşılan sülfasalazinin tetiklediği akciğer olgumuz ve bu durumun tedavisine değindik.

Keywords

sülfasalazin, intestisyel akciğer hastalığı, akut akciğer hasarı, ankilozan spondilit

References

• 1. Fagan LN, Foral AP, Malesker MA, Morrow EL. Therapeutic update on Drug-Induced pulmonary disorders. US Pharm. 2011; 36(7):HS3-HS8.
• 2. Coultas DB, Zumwalt RE, Black WC, Sobonya RE. The epidemiology of interstitial lung diseases. Am J Respir Crit Care Med. 1994 ; 150(4):967-72.
• 3. International Multidisciplinary Concensus. Classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med. 2002;165:277-304.
• 4. Raghu G, Nyberg F, Morgan G. The epidemiology of interstitial lung disease and its association with lung cancer. Br J Cancer. 2004; 91(S2): S3–S10.
• 5. Bradley B, Branley HM, Egan JJ, Greaves MS, et al. British Thoracic Society Interstitial Lung Disease Guideline Group, British Thoracic Society Standards of Care Committee; Thoracic Society of Australia; New Zealand Thoracic Society; Irish Thoracic Society. Interstitial lung disease guideline: the British Thoracic Society in collaboration with the Thoracic Society of Australia and New Zealand and the Irish Thoracic Society. Thorax. 2008 Sep;63 Suppl 5:v1-58. doi: 10.1136/thx.2008.101691.
• 6. Matsuno O. Drug-induced interstitial lung disease: mechanisms and best diagnostic approaches. Respir Res. 2012; 13: 39.
• 7. Momeni M, Taylor N, Tehrani M. Cardiopulmonary manifestations of ankylosing spondylitis. Int J Rheumatol. 2011;2011:728471.
• 8. Chwaiblmair M, Behr W, Haeckel T, Markl B, Foerg W, Berghaus T. Drug Induced Interstitial Lung Disease. Open Respir Med J. 2012; 6: 63-74.
• 9. Skeoch S, Weatherley N, Swift AJ, Oldroyd A, Johns C, Hayton C et al. Drug-Induced Interstitial Lung Disease: A Systematic Review. J Clin Med. 2018;7(10):356.
• 10. Bahat G, Celik HG, Tufan F, Saka B. Drug rash with eosinophilia and systemic symptoms syndrome induced by sulfasalazine. Joint Bone Spine. 2010;77(1):87–88.
• 11. Mohyuddin GR, Sultan F, Zhang K, Khaleeq G. Sulfasalazine induced lung toxicity masquerading as sarcoidosis--case report and review of the literature. Sarcoidosis Vasc Diffuse Lung Dis. 2013;30(3):226-30.
• 12. Parry SD, Barbatzas C, Peel ET, et al., Sulphasalazine and lung toxicity, Eur Respir J 19(4) (2002) 756-64. https://doi.org/10.1183/09031936.02.00267402
• 13. Nadarajan P, Fabre A, Kelly E. Sulfasalazine: A rare cause of acute eosinophilic pneumonia. Respir Med Case Rep. 2016;18:35–36.
• 14. Miura N, Aoyama R, Kitagawa W, Yamada H, Nishikawa K, Imai H. Proteinase 3-antineutrophil cytoplasmic antibody-(PR3-ANCA) positive necrotizing glomerulonephritis after restarting sulphasalazine treatment. Clin Nephrol. 2009;71(1):74-9.