Sulfasalazine
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Drug-induced hypersensitivity syndrome: case report A 43-year-old woman was hospitalised due to drug-induced hypersensitivity syndrome (DIHS) after she started receiving sulfasalazine [salazosulfapyridine] for newly diagnosed rheumatoid arthritis. The woman developed fever (38.3°C) and a rash on her extremities, 2 weeks after initiation of sulfasalazine 1000 mg/day. Sulfasalazine was discontinued but, over the following 2 weeks, she developed a generalised rash, lymphadenopathy and facial oedema. Laboratory analyses revealed a WBC count of 44 400/mm3 (including 32.0% atypical lymphocytes) and elevated liver enzyme and Creactive protein levels, but no elevations in antiviral antibody levels. An ultrasound identified multiple enlarged lymph nodes and marked splenomegaly. Nonsteroidal anti-inflammatories and antihistamines were administered. The woman’s fever, rash and lymphadenopathy improved, and she was discharged. However, her splenomegaly and skin rash persisted and, 3 weeks later, a second elevation of her liver enzymes occurred; prednisolone was then initiated and these symptoms resolved. Sulfasalazine-related DIHS was suspected, due to the absence of an elevation in viral antibody levels and the patient’s biphasic clinical course. Subsequent in vitro drug-induced lymphocyte stimulation tests with sulfasalazine and its two major metabolites (sulfapyridine and 5-ASA) were strongly positive. Author comment: This patient met six of the seven proposed diagnostic criteria for DIHS, namely: skin rash; persistence of reaction for > 2 weeks following suspect drug cessation; fever; liver dysfunction; leucocytosis, atypical lymphocytosis or eosinophilia; and lymphadenopathy; she was not tested for the seventh criterion (reactivation of human herpesvirus-6 infection). Furukawa K, et al. Infectious mononucleosis-like syndrome induced by salazosulfapyridine in a patient with rheumatoid arthritis. Modern rheumatology / the Japan Rheumatism Association 17: 492-495, No. 6, Dec 2007 801079725 Japan
0114-9954/10/1186-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 26 Jan 2008 No. 1186
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