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Sulphasalazine and lung toxicity.

S D Parry1, C Barbatzas, E T Peel

  • 1Northumbria Division, University of Newcastle Faculty of Medicine, North Tyneside Hospital, North Shields, UK.

The European Respiratory Journal
|May 10, 2002
PubMed
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Sulphasalazine lung disease is a rare complication, often presenting with dyspnea and cough. Most patients recover after drug withdrawal, though corticosteroids may be used.

Area of Science:

  • Pulmonology
  • Pharmacology
  • Internal Medicine

Background:

  • Sulphasalazine prescribing is increasing globally.
  • Pulmonary toxicity and blood dyscrasias are rare but serious side-effects.
  • Numerous case reports link sulphasalazine to lung toxicity.

Purpose of the Study:

  • To review and analyze published cases of sulphasalazine-induced lung toxicity.
  • To characterize the clinical presentation, pathology, and management of this rare adverse effect.

Main Methods:

  • Systematic literature search of Medline and PubMed databases.
  • Inclusion of case reports and letters mentioning sulphasalazine and lung toxicity.
  • Analysis of 50 identified cases focusing on symptoms, radiographic findings, pathology, and treatment outcomes.

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Main Results:

  • Typical presentation includes new-onset dyspnea and chest radiographic infiltrates, with cough and fever as common symptoms.
  • Peripheral eosinophilia and crepitations were present in about half of the cases.
  • Eosinophilic pneumonia and interstitial inflammation were the most frequent pulmonary pathologies; fatal outcomes were infrequent.

Conclusions:

  • Sulphasalazine-induced lung disease requires differentiation from underlying interstitial lung diseases.
  • Despite increased sulphasalazine use, pulmonary toxicity remains rare.
  • Most patients improve with drug withdrawal alone, questioning the routine need for corticosteroids.