Sulfasalazine
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Systemic lupus erythematosus: case report A 47-year-old woman with rheumatoid arthritis developed systemic lupus erythematosus during treatment with sulfasalazine. The woman, who was receiving methotrexate and corticosteroids, began treatment with sulfasalazine [route and dosage not stated] for fever and developed erythema on her back, swollen cheeks, and a swollen nose three weeks later. Skin complaints, when exposed to sunshine, followed. She then developed palpitations, chest pain, and dyspnoea and was admitted to a cardiology clinic in August 2009. Echocardiography revealed pericardial effusion and she also had leucocytosis. She was diagnosed with pericarditis and ciprofloxacin and ceftriaxone were started. Examination revealed swelling, pain, and increased temperature in her metacarpophalangeal and carpometacarpal joints. She also had limited motion in her left knee, and swan-neck deformity and ulnar deviation in both her hands. Examination revealed a BP of 90/60mm Hg and a cardiac pulse rate of 120/min. Laboratory tests showed the following: haemoglobin 11.5 g/dL, leucocyte count 18000, ESR 34 mm/hour, CRP 18.5 mg/dL, ALT 40 U/L, GGT 283 U/L, AST 35 U/L, LDH 730 U/L, rheumatoid factor 141 IU/mL, and anti-CCP antibody was positive. The woman was treated with prednisolone and fluid accumulation was deemed minimal after 3 days, according to echocardiography. Sulfasalazine was discontinued. Five days later, her echocardiography results were normal. Taking into account all radiological, laboratory, and clinical findings, she was diagnosed with drug-induced lupus erythematosus due to the use of sulfasalazine. Her cardiac examination and liver enzyme levels were normal prior to discharge. After discharge, she continued on prednisolone, methotrexate, and folic acid. Hiz O, et al. Pleuropericarditis associated with sulphasalazine in a case of rheumatoid arthritis: A drug-induced lupus-like syndrome. Turkish Journal of Rheumatology 26: 248-253, No. 3, Sep 2011. Available from: URL: http:// 803064201 dx.doi.org/10.5152/tjr.2011.039 - Turkey
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Reactions 17 Dec 2011 No. 1382
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