Year 2024 / Volume 116 / Number 5
Letter
Mesalazine-induced esophageal ulcers. A rare adverse effect

294-295

DOI: 10.17235/reed.2023.9723/2023

Raúl José Díaz Molina, Carlos Comesaña Castellar, Marcelo García Hernández, Carmen Garrido Durán, Marco Antonio Martínez Ortega, Daniel Ginard Vicens,

Abstract
31-year-old woman. Diagnosis of ulcerative proctitis in February/2022. Calprotectin 1832 μg/g. Colonoscopy: erythematous, friable and erosive mucosa up to 10 cm from the anal margin. Pathology: compatible with ulcerative colitis with moderate activity. Start of oral mesalazine (3 gr/24 h granules) and topical (1 gr/24 h suppository). After three months, she achieved clinical remission. Calprotectin 57 μg/g. Two months later, she consulted for solid dysphagia, loss of 10 kg, and low-grade fever for a month. Fifteen days before, she went to an emergency room where Prednisone 50 mg/24 h was started. On the day of the assessment, she was receiving 30 mg with no improvement. The next day, gastroscopy showed 6-12 mm esophageal ulcers with non-confluent shallow geographic borders, biopsies were taken. Viral serologies and HLA B51 were requested. Given the severity of the symptoms, empirical treatment was started with Valaciclovir 1 g/12 h. Serologies: IgG for Ebstein Barr virus, cytomegalovirus and herpes virus with negative IgM. Cytomegalovirus viral load: <30 IU/ml. Pathology: acute extensively ulcerated esophagitis, inflammatory infiltrate and some eosinophils with negative histochemical staining for fungi, cytomegalovirus and herpes virus I and II. HLA B51 was negative. Valaciclovir and mesalazine are discontinued after seven days given the known relationship of the latter with low-grade fever and, exceptionally, with esophageal pathology. Three days later, the patient reported clear improvement in dysphagia from the day the mesalazine was discontinued. After eight months, she was still asymptomatic. Upon resolution of the symptoms, control gastroscopy was not performed, and mesalazine has not been reintroduced due to its probable causal association. Mesalazine has an excellent safety profile. Adverse effects include fever, headache, diarrhea and
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References
1- López-Cepero Andrada JM, López Silva M, Salado Fuentes M, et al. Ulcera esofágica por mesalazina [Esophageal ulcer due to mesalazine]. Gastroenterol Hepatol. 2000 Aug-Sep;23(7):362.
2- Park J, Cheon JH. Updates on conventional therapies for inflammatory bowel diseases: 5-aminosalicylates, corticosteroids, immunomodulators, and anti-TNF-α. Korean J Intern Med. 2022 Sep;37(5):895-905.
3- Tsujii Y, Nishida T, Osugi N, et al. Classification and clinical features of adverse drug reactions in patients with ulcerative colitis treated with 5-aminosalicylate acid: a single-center, observational study. Scand J Gastroenterol. 2022 Feb;57(2):190-196
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Citation tools
Díaz Molina R, Comesaña Castellar C, García Hernández M, Garrido Durán C, Martínez Ortega M, Ginard Vicens D, et all. Mesalazine-induced esophageal ulcers. A rare adverse effect. 9723/2023


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Publication history

Received: 15/05/2023

Accepted: 03/06/2023

Online First: 22/06/2023

Published: 09/05/2024

Article Online First time: 38 days

Article editing time: 360 days


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