Summary
We report a 53-year-old man with sero-negative rheumatoid arthritis who developed a fever, rash and hepatitis 3 weeks after starting sulphasalzine therapy. This was associated with a T cell lymphocytosis, eosinophilia and evidence of classical complement pathway activation. He responded to high dose corticosteroids. This is a rare but characteristic reaction which is likely to be encountered by rheumatologists more frequently with the increasing use of sulphasalazine. It should be recognized promptly as it may be fatal and can be confused with other systemic diseases.
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References
Porter, D.R., Capell, H.A. The use of sulphasalazine as a disease modifying drug. Baillieres Clin Rheumatol 1990, 4, 535–541.
Farr, M., Scott, D.G., Bacon, P.A. Side effect profile of 200 patients with inflammatory arthritides treated with sulphasalazine. Drugs 1986, 32 Suppl 1, 49–53.
Amos, R.S., Pullar, T., Bax, D.E., Situnayake, D., Capell, H.A., McConkey, B.: Sulphasalazine for rheumatoid arthritis: toxicity in 774 patients monitored for one to 11 years. Br Med J Clin Res 1986, 293, 420–423.
Donovan, S., Hawley, S., MacCarthy, J., Scott, D.L. Tolerability of enteric coated sulphasalazine in rheumatoid arthritis: results of a cooperating clinics study. Br J Rheumatol 1990, 29, 201–204.
Haines, J.D. Jr. Hepatotoxicity after treatment with sulphasalazine. Postgrad Med 1986, 79, 193–198.
Ribe, J., Benkov, K.J., Thung, S.N., Shen, S.C., LeLeiko, N.S. Fatal massive hepatic necrosis: a probable hypersensitivity reaction to sulphasalazine. Am J Gastroenterol 1986, 81, 205–208.
Kojis, F.J. Serum sickness and anaphylaxis: analysis of cases of 6,211 patients treated with horse serum for various infections. Am J Dis Child 1942, 64, 93–143.
Hunt, L.W. Recent observations in serum disease. JAMA 1932, 99, 909–912.
Germuth, F.C.Jr. A comparative histologic and immunologic study in rabbits of induced hypersensitivity of the serum sickness type. J Exp Med 1953, 97, 257–282.
Dixon, F.J., Feldman, J.D., Vasquez, J.J. Experimental glomerulonephritis: the pathogenesis of a laboratory model resembling the spectrum of human glomerulonephritis. J Exp Med 1961, 113, 899–920.
Lawley, T.J., Bielory, L., Gascon, P., Yancey, K.B., Young, N.S., Frank, M.M. A prospective clinical and immunologic analysis of patients with serum sickness. N Engl J Med 1984, 311, 1407–1413.
Das, K.M., Chowdhury, J.R., Zapp, B., Fara, J.W. Small bowel absorption of sulfasalazine and its hepatic metabolism in human beings, cats and rats. Gastroenterol 1979, 77, 280–284.
Mihas, A.A., Goldenberg, D.J., Slaughter, R.L. Sulfasalazine toxic reactions. Hepatitis, fever and skin rash with hypocomplementemia and immune complexes. JAMA 1978, 239, 2590–2591.
Carr-Locke, D.L., Ali, M. Glandular fever-like illness associated with sulphasalazine. Postgrad Med J 1982, 58, 665–666.
Pearl, R.K., Nelson, R.L., Prasad, M.L., Orsay, C.P., Abcarian, H. Serious complications of sulphasalazine. Dis Colon Rectum 1986, 29, 201–202.
Pettersson, T., Gripenberg, M., Molander, G., Friman, C. Severe immunological reaction induced by sulphasalazine. Br J Rheumatol 1990, 29, 239–240.
Vyse, T., So, A.K.L. Sulphasalazine induced autoimmune syndrome. Br J Rheumatol 1992, 31, 115–116.
Caspi, D., Fuchs, D., Yaron, M., Sulphasalazine induced hepatitis in juvenile rheumatoid arthritis. Ann Rheum Dis 1992, 51, 275–276.
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Brooks, H., Taylor, H.G. & Nichol, F.E. The three week sulphasalazine syndrome. Clin Rheumatol 11, 566–568 (1992). https://doi.org/10.1007/BF02283121
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DOI: https://doi.org/10.1007/BF02283121