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Case report
Maternal mesalazine-induced neonatal gastrointestinal bleeding
  1. Kohichiroh Nii1,
  2. Kaoru Okazaki2,
  3. Hitoshi Okada3 and
  4. Toru Kuboi1
  1. 1Department of Neonatology, Shikoku Medical Center for Children and Adults, Zentsuji, Kagawa, Japan
  2. 2Division of Neonatology, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan
  3. 3Department of Pediatrics, Kagawa University, Miki-cho, kitagun, Kagawa, Japan
  1. Correspondence to Dr Kohichiroh Nii; knii0704{at}gmail.com

Abstract

Ulcerative colitis often develops in the reproductive age women and can cause exacerbation by pregnancy. Mesalazine (5-aminosalicylic acid) is recommended as a safe anti-inflammatory drug during pregnancy. However, maternal mesalazine is transferred to the fetus through the placenta and may cause allergic events. A pregnant woman with severe ulcerative colitis was treated with a dose of mesalazine 4,000 mg/day from early gestation to delivery. Immediately after birth, the preterm neonate vomited bloody contents and discharged massive gross haematochezia. Serum concentrations of mesalazine and its main metabolite were high in the mother and the umbilical cord. Faecal eosinophils and drug-induced lymphocyte stimulation test suggested possibility that sensitisation with mesalazine in utero caused allergic enterocolitis like food protein-induced allergic proctocolitis. Maternal mesalazine has a potential of fetal sensitisation and cause allergic disease.

  • GI bleeding
  • immunology
  • neonatal intensive care
  • drugs: obstetrics and gynaecology
  • pharmacodynamics

https://doi.org/10.1136/bcr-2020-238743

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    Footnotes

    • Contributors KN: planning of report, conduct of the study, reporting, acquisition of data and drafting the article. KO: planning of report, conduct of the study and revising the article critically for important intellectual content. HO: analysis of data. TK: conduct of the study and final approval of the version published.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.