Sulfasalazine-associated encephalopathy in a patient with Crohn's disease.
We report a case of acute encephalopathy in a patient with Crohn's disease who had taken sulfasalazine for 1 month. The development of toxic hepatitis and dermatitis prompted interruption of the drug. Four days later, neurologic symptoms became evident. These included acute monoparesis of the left arm, the development of stupor and coma, with endorotation of both arms, and a left Babinski sign. CT and MR imaging revealed multiple lesions in the white and gray brain matter, suggesting diffuse cerebral microangiitis. All cerebrospinal fluid examinations were negative. Methylprednisolone was given intravenously. Complete clinical normalization followed. Neurotoxicity secondary to sulfasalazine has seldom been reported in the literature. We found certain similarities with two previous case reports suggesting a hypersensitivity reaction to sulfasalazine or one of its metabolites. For ethical reasons, no rechallenge was performed.
Schoonjans
R
R
Department of Gastroenterology, Algemene Kliniek H. Familie, Ghent, Belgium.
Mast
A
A
Van den Abeele
G
G
Dewilde
D
D
Achten
E
E
Van Maele
V
V
Pauwels
W
W
D000328:Adult; D001927:Brain Diseases / Q000139:chemically induced*; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology; D003424:Crohn Disease / Q000188:drug therapy*; D003875:Drug Eruptions / Q000209:etiology; D004342:Drug Hypersensitivity / Q000209:etiology*; D006801:Humans; D008297:Male; D012460:Sulfasalazine / Q000009:adverse effects* / Q000627:therapeutic use
D012460:Sulfasalazine