Is it Crohn's disease? A severe systemic granulomatous reaction to sulfasalazine in patient with rheumatoid arthritis.
BACKGROUND
Sulfasalazine is a widely used anti-inflammatory agent in the treatment of inflammatory bowel disease and several rheumatological disorders. Although as many as 20% of treated patients may experience reversible, dose-dependent side effects, less frequent but potentially severe, systemic reactions have also been reported.


METHODS
A severe systemic reaction to sulfasalazine developed in a 21-year old female with rheumatoid arthritis characterized by eosinophilia, granulomatous enteritis and myelotoxicity, cholestatic hepatitis, and seizures. The clinical course and management of this patient are presented as well as a review of the incidence and outcome of severe systemic reactions to sulfasalazine.


CONCLUSIONS
Granulomatous myelotoxicity and enteritis developed in a 21 year old female within 3 weeks of initiating sulfasalazine for rheumatoid arthritis. Following a short course of corticosteroids, the patient had resolution of her cholestatic hepatitis, rash, eosinophilia, and gastrointestinal symptoms with no residual manifestations at 7 months follow-up. Although severe reactions to sulfasalazine are rare and unpredictable, practicing physicians should be aware of unusual clinical presentations of toxicity when prescribing sulfasalazine.
Quallich
L G
LG
Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan 48109, USA. lquall@umich.edu
Greenson
J
J
Haftel
H M
HM
Fontana
R J
RJ
D000328:Adult; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis; D003424:Crohn Disease / Q000139:chemically induced / Q000175:diagnosis; D003937:Diagnosis, Differential; D004751:Enteritis / Q000139:chemically induced / Q000175:diagnosis; D004802:Eosinophilia / Q000139:chemically induced* / Q000175:diagnosis; D005260:Female; D006099:Granuloma / Q000139:chemically induced* / Q000175:diagnosis; D006801:Humans; D012640:Seizures / Q000139:chemically induced; D012460:Sulfasalazine / Q000009:adverse effects*
D018501:Antirheumatic Agents; D012460:Sulfasalazine