Sulfasalazine
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DRESS syndrome in a child: case report An 11-year-old girl developed DRESS syndrome (drug reaction with eosinophilia and systemic symptoms) shortly after starting low-dose sulfasalazine for ulcerative colitis. Following diagnosis of ulcerative colitis, the girl started sulfasalazine therapy with the dosage increased to 1.5 g/day over 1 week. Her medical history was remarkable for primary sclerosing cholangitis with cirrhosis and portal hypertension; she had no previous drug allergies. Within 1 week of starting therapy, she developed a rash on her face and trunk, fever and worsening diarrhoea. She was hospitalised for 24 hours, then discharged with a diagnosis of viral exanthema. Her rash progressed to involve all four limbs and became intensely pruritic, and her fever persisted. A drug reaction was suspected and sulfasalazine was stopped. However, the girl’s clinical status continued to deteriorate and she was admitted to another facility. Physical examination was notable for fever (39.4°C), pulse 110bpm, BP 91/43mm Hg and a respiratory rate of 20bpm, as well as a widespread skin eruption, facial oedema, mild cervical lymphadenopathy, palpable liver edge and spleen, and a new systolic murmur. Laboratory test results were notable for marked leucocytosis, eosinophilia, increased ESR and an elevated CRP level. Testing excluded infectious causes. She received empirical antibiotics for sepsis but her symptoms persisted. Repeat blood tests showed progressive deterioration, including worsening liver function and increasing eosinophilia. IV methylprednisolone was started and her clinical status began to improve within 6 hours; her skin rash and abnormal test results improved over the following few days. Skin biopsy results were consistent with a drug eruption and DRESS syndrome was diagnosed. She was discharged receiving a tapered course of prednisolone and was advised to avoid all medicines containing 5-aminosalicylic acid and sulfonamides. Rosenbaum J, et al. Drug rash with eosinophilia and systemic symptoms secondary to sulfasalazine. Journal of Paediatrics and Child Health 46: 193-196, No. 4, Apr 2010. Available from: URL: http://dx.doi.org/10.1111/j.1440-1754.2009.01660.x 803021722 Australia
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Reactions 26 Jun 2010 No. 1307
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