title: Acute myocardial infarction in a 56-year-old female patient treated with sulfasalazine.
abstract: Drug rash, eosinophilia, and systemic symptoms (DRESS) syndrome represents one pattern of the cutaneous involvement in type IV hypersensitivity reaction to drugs. It is a severe, delayed, idiosyncratic reaction presented as rash with fever, lymphadenopathy, and visceral involvement. There are several reported cases of sulfasalazine-induced DRESS syndrome, but myocardial involvement was rare. High index of suspicion is needed in every patient receiving these drugs for prompt diagnosis and early management. We report a case of a 56-year-old woman treated with sulfasalazine for ankylosing spondylitis for 3 weeks, which was discontinued after development of DRESS syndrome. Despite treating her with high dose of steroid and cyclosporine, her symptoms persisted, and ultimately, she developed toxic myocarditis with a misleading presentation of acute ST-elevated myocardial infarction. The diagnosis was made based on postmortem histopathologic finding.
authors.affiliation: Section of Adult Cardiology, Cardiovascular Department, King Faisal Specialist Hospital & Research Center-Jeddah, P.O. Box 40047, Jeddah 21499, Kingdom of Saudi Arabia. amindaoulah@yahoo.com
authors.forename: Amin
authors.initials: A
authors.lastname: Daoulah
authors.forename: Awad A R
authors.initials: AA
authors.lastname: Alqahtani
authors.forename: Sara R
authors.initials: SR
authors.lastname: Ocheltree
authors.forename: Abdulkarim
authors.initials: A
authors.lastname: Alhabib
authors.forename: Ali R
authors.initials: AR
authors.lastname: Ocheltree
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use; D004562:Electrocardiography; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000139:chemically induced* / Q000473:pathology; D009206:Myocardium / Q000473:pathology; D013167:Spondylitis, Ankylosing / Q000188:drug therapy; D012460:Sulfasalazine / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D012460:Sulfasalazine