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Sulfasalazine Pulmonary Toxicity in Ulcerative Colitis Mimicking Clinical Features of Wegener's Granulomatosis FREE TO VIEW

Stephen M. Salerno; Eric J. Ormseth; Bernard J. Roth; Cristopher A. Meyer; Erik D. Christensen; Thomas A. Dillard
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From the Departments of Medicine, Radiology, and Pathology, Madigan Army Medical Center, Tacoma, Wash.

1996 by the American College of Chest Physicians

Chest. 1996;110(2):556-559. doi:10.1378/chest.110.2.556
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The centrally accentuated antineutrophil cytoplasmie antibody test (c-ANCA) is widely regarded as a sensitive and specific marker for Wegener's granulomatosis (WG). There are increasing reports, however, of false-positive c-ANCAs, usually in the setting of other vasculidities. We report a case of a 27-year-old man with ulcerative colitis who developed pulmonary symptoms, peripheral nodular lung infiltrates, and an elevated c-ANCA suggesting WG. Chest CT and open lung biopsy specimens were consistent with WG. The symptoms and pulmonary infiltrates resolved 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 patients with ulcerative colitis.




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