[Sulfasalazine-induced pulmonary infiltrates and Legionella pneumonia]

After 2 weeks' treatment with sulfasalazine (SASP) and mesalazine enema, a 32-year-old female with recently diagnosed ulcerative colitis developed bilateral pulmonary infiltrates with peripheral eosinophilia. Both drugs were discontinued. In view of a high-positive antibody titre (1:4096) against Legionella pneumophila serogroups 1-5, legionnaires' disease was assumed and empirical antilegionella therapy with macrolid antibiotic was started. The patient's condition improved within days. Three months later SASP was given again in view of exacerbation of the inflammatory bowel disease. Three days after initiation of therapy acute pulmonary symptoms again developed with bilateral, confluent opacities and blood eosinophilia. The abnormalities resolved completely after the drug was discontinued and prophylactic antibiotic therapy was given. Peripheral lung infiltrates with blood eosinophilia are a rare side effect of SASP therapy. The prognosis of the illness after the drug has been discontinued is generally good, usually with complete recovery of pulmonary function. The risk factors for sulfasalazine pulmonary toxicity are not well known. We describe the first case of SASP-induced hypersensitivity lung disease with simultaneous Legionella pneumophila infection.