SULFASALAZINE PULMONARY TOXICITY IN ULCERATIVE-COLITIS MIMICKING CLINICAL-FEATURES OF WEGENERS GRANULOMATOSIS

The centrally accentuated antineutrophil cytoplasmic antibody test (c- ANCA) is widely regarded as a sensitive and specific marker for Wegene r's granulomatosis (WG). There are increasing reports, however, of fal se-positive c-ANCAs, usually in the setting of other vasculidities. We report a case of a 27-year-old man with ulcerative colitis who develo ped pulmonary symptoms, peripheral nodular lung infiltrates, and an el evated c-ANCA suggesting WG. Chest CT and open lung biopsy specimens w ere consistent with WG. The symptoms and pulmonary infiltrates resolve d after discontinuation of sulfasalazine therapy. The c-ANCA remained elevated due to the occurrence of false-positive values in ulcerative colitis. We conclude sulfasalazine toxicity can mimic clinical aspects of WG and that c-ANCA testing should be interpreted with caution in p atients with ulcerative colitis.