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The 3-week sulphasalazine syndrome strikes again
1Department of Forensic Medicine, Institute of Science and Forensic Medicine, Outram Road, Singapore 169608, Singapore.
Forensic Science International
|October 24, 2001
Summary
A rare "3-week sulphasalazine syndrome" caused severe illness and death in a patient with rheumatoid arthritis. This immunoallergic reaction led to multi-organ failure, highlighting the risks of sulphasalazine.
Area of Science:
- Immunology
- Pharmacology
- Pathology
Background:
- Sulphasalazine is a disease-modifying antirheumatic drug used for rheumatoid arthritis.
- Adverse drug reactions can manifest with diverse and severe clinical presentations.
Observation:
- A 34-year-old female developed dermatitis, fever, lymphadenopathy, and hepatitis 17 days after starting oral sulphasalazine.
- Lymph node biopsies revealed necrotizing lymphadenitis with erythrophagocytosis and eosinophilic infiltrates.
- Fulminant drug-induced hepatitis, multi-organ failure, and sepsis occurred one week later.
Findings:
- Post-mortem examination showed hepatocellular necrosis, hypersensitivity myocarditis, tubulo-interstitial nephritis, and bone marrow necrosis.
- The clinical and pathological features were consistent with the "3-week sulphasalazine syndrome."
- This syndrome is a rare, potentially fatal immunoallergic reaction to sulphasalazine.
Implications:
- This case underscores the importance of recognizing the "3-week sulphasalazine syndrome" as a rare but critical adverse drug reaction.
- Early identification and cessation of sulphasalazine may be crucial for managing this severe immunoallergic response.
- Further research into the mechanisms of sulphasalazine-induced hypersensitivity reactions is warranted.