title: Sulfasalazine-induced hypersensitivity syndrome and hemophagocytic syndrome associated with reactivation of Epstein-Barr virus.
abstract: A 58-year-old woman with rheumatoid arthritis (RA) developed fever, skin eruptions, leukocytopenia, and thrombocytopenia, 3 weeks after treatment with sulfasalazine. A skin biopsy showed hydropic degeneration of keratinocytes and lymphocytic infiltrate. A bone marrow aspiration demonstrated an increased number of macrophages with hemophagocytosis. Although serologic tests for Epstein-Barr virus (EBV) indicated a previous infection, EBV deoxyribonucleic acid was detected in her serum by polymerase chain reaction. Cessation of sulfasalazine and administration of steroids led to dramatic improvement. This case illustrates that the hemophagocytic syndrome associated with reactivation of EBV can occur as part of drug hypersensitivity reactions in RA patients taking sulfasalazine.
authors.affiliation: Third Department of Internal Medicine, Akita University School of Medicine, 1-1-1 Hondo, Akita, Akita, 010-8543, Japan. komatsud@med.akita-u.ac.jp
authors.forename: Atsushi
authors.initials: A
authors.lastname: Komatsuda
authors.forename: Yohsuke
authors.initials: Y
authors.lastname: Okamoto
authors.forename: Takashi
authors.initials: T
authors.lastname: Hatakeyama
authors.forename: Hideki
authors.initials: H
authors.lastname: Wakui
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Sawada
mesh_terms: D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy; D004342:Drug Hypersensitivity / Q000209:etiology* / Q000821:virology; D020031:Epstein-Barr Virus Infections / Q000150:complications*; D005260:Female; D006801:Humans; D051359:Lymphohistiocytosis, Hemophagocytic / Q000209:etiology / Q000821:virology*; D008875:Middle Aged; D012859:Sjogren's Syndrome / Q000150:complications / Q000188:drug therapy; D012460:Sulfasalazine / Q000009:adverse effects*; D017735:Virus Latency / Q000187:drug effects*
chemical_list: D018501:Antirheumatic Agents; D012460:Sulfasalazine