Are there any case reports describing severe thrombocytopenia in a breast-fed infant when the mothe

Fråga: Are there any case reports describing severe thrombocytopenia in a breast-fed infant when the mother has been treated with mesalazine? A 3-month-old infant developed petechiae and thrombocytopenia (6-7x10E9/l, reference interval 150-400x10E9/l). The child was breast-fed from birth and the mother was treated with mesalazine (Pentasa) four tablets of 500 mg per day. The mother stopped breast-feeding and the thrombocytes increased to 60x10E9/l. Follow up 980901: the infant has now low thrombocytes again (26x10E9/l) and an examination of the bone marrow is planned.

Sammanfattning: There are no case reports in the literature describing severe thrombocytopenia in a breast-fed infant when the mother is treated with mesalazine.

Svar: Thrombocytopenia is a rare adverse effect in patients treated with mesalazine. Bioavailability is 30- 50 per cent and the half-life is about 15 hours.

Mesalazine is excreted into human milk (1,2). According to the literature there are no case reports describing thrombocytopenia in breast-fed infants when the mother is treated with mesalazine. The only reaction described is diarrhea in a nursed child, apparently as a result of the rectal administration of mesalazine to the mother (3). The reaction stopped after cessation and after several re-exposures diarrhea occurred again. The American Academy of Pediatrics classifies mesalazine not to be used during breast-feeding (2).