EXACERBATION OF CHRONIC ULCERATIVE-COLITIS WITH MESALAMINE

Activation of ulcerative colitis with mesalamine has rarely been repor ted. In case 1, a 34-year-old man was treated with oral mesalamine, re sulting in an exacerbation of colitis that rapidly improved with gluco corticoids and mesalamine withdrawal. Oral cromolyn sodium and occasio nal low-dose prednisone therapy has maintained long-term remission. In case 2, a 28-year-old man receiving prednisone treatment developed ch est pain and myalgias 1 week after initiation of mesalamine that resol ved on mesalamine withdrawal. A lower dose of mesalamine with continue d glucocorticoids resulted in clinical improvement, and both drugs wer e tapered. Mesalamine sensitivity was documented endoscopically and hi stologically by evaluating mucosal changes after two mesalamine enemas during a 24-hour period. There was dramatic progression from quiescen t disease to active colitis in 24 hours. Mesalamine sensitivity must b e included in the differential diagnosis of ulcerative colitis exacerb ations. Concurrent steroid therapy can suppress systemic side effects, making the diagnosis even more elusive.