DOI: 10.12890/2026_006544

Recurrent pleuropericarditis associated with mesalazine therapy masked by steroid use

Authors

  • Hakan Demiröz Department of Gastroenterology, Ondokuz Mayıs University, Samsun, Turkey 0000-0002-1713-7682
  • Hasan Eruzun Department of Gastroenterology, Samsun Training and Research Hospital, Samsun, Turkey 0000-0003-0355-1820
  • Handan Doğan Çakmak Department of Internal Medicine, Ondokuz Mayıs University, Samsun, Turkey 0000-0002-0606-2400
  • Aydın Can Ulusoy Department of Cardiology, Ondokuz Mayıs University, Samsun, Turkey 0009-0006-1308-6159
  • Yusuf Bünyamin Ketenci Department of Gastroenterology, Ondokuz Mayıs University, Samsun, Turkey 0000-0003-0372-9166
  • Mehmet Akca Department of Gastroenterology, Ondokuz Mayıs University, Samsun, Turkey 0000-0002-1507-1851
  • Ahmet Bektaş Department of Gastroenterology, Ondokuz Mayıs University, Samsun, Turkey 0000-0001-7026-9353

hakandemiroz.90@gmail.com

Keywords

Mesalamine, ulcerative colitis, pericardial effusion, pleural effusion, drug toxicity

Abstract

Introduction: Mesalazine is a cornerstone therapy for ulcerative colitis (UC). Although generally safe, it can cause rare but life-threatening cardiopulmonary complications such as pleuropericarditis.
Case description: We report on a patient with a UC flare who presented with dyspnoea, where concurrent pericardial and pleural effusions were detected. The inflammatory response was likely suppressed by concomitant corticosteroid therapy, which masked the clinical manifestations of mesalazine-induced serositis and delayed diagnosis. Two years later, the patient re-presented with recurrent massive pericardial effusion causing tamponade physiology and pleural effusion. Pericardial fluid analysis revealed a haemorrhagic, neutrophil-dominant profile (95% polymorphonuclear leukocyte, mimicking bacterial infection rather than the typically described eosinophilic pattern. Extensive cultures were negative. Following the discontinuation of mesalazine, rapid clinical and radiologic improvement was observed, confirming drug-induced pleuropericarditis.
Discussion: This case highlights that mesalazine-associated pleuropericarditis can be obscured by corticosteroids, leading to diagnostic delays. Furthermore, sterile inflammatory reactions to mesalazine can present with atypical neutrophilic features resembling bacterial infection, necessitating a high index of suspicion in inflammatory bowel disease patients presenting with serositis.

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References

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Published

2026-04-20

Issue

Vol. 13 No. 5 (2026)

Categories

How to Cite

1.
Demiröz H, Eruzun H, Doğan Çakmak H, Ulusoy AC, Ketenci YB, Akca M, et al. Recurrent pleuropericarditis associated with mesalazine therapy masked by steroid use. EJCRIM [Internet]. 2026 Apr. 20 [cited 2026 Nov. 3];13(5). Available from: https://ejcrim.com/index.php/ejcrim/article/view/6544