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Updated: Jun 27, 2026
26:48
Induction and Clinical Scoring of Chronic-Relapsing Experimental Autoimmune Encephalomyelitis
Published on: July 4, 2007
Reversible encephalopathy due to sulfasalazine
Senem E Mut1, Gulnihal Kutlu, Serap Ucler
1Department of Neurology, Ankara Research and Training Hospital, Ministry of Health, Ankara, Turkey.
Clinical Neuropharmacology
|December 4, 2008
Summary
Sulfasalazine, an anti-inflammatory drug, can cause severe neurotoxicity, including status epilepticus and brain lesions. Prompt discontinuation of sulfasalazine led to rapid recovery in a rheumatoid arthritis patient.
Area of Science:
- Neurology
- Rheumatology
- Pharmacology
Background:
- Sulfasalazine is a widely used anti-inflammatory drug for rheumatologic disorders and inflammatory bowel diseases.
- While generally safe, severe systemic reactions to sulfasalazine are occasionally reported.
Observation:
- A 42-year-old woman with rheumatoid arthritis developed status epilepticus, hepatitis, and myelotoxicity after 3 weeks of 2g daily sulfasalazine.
- Cranial MRI revealed white matter lesions, and CSF analysis showed significantly elevated protein levels.
- These symptoms emerged after excluding other potential causes of encephalitis.
Findings:
- Sulfasalazine treatment was associated with neurotoxicity, manifesting as status epilepticus.
- Cranial MRI demonstrated characteristic periventricular and subcortical white matter lesions.
- Cerebrospinal fluid abnormalities, including markedly elevated protein, were observed.
Implications:
- This case highlights sulfasalazine-induced neurotoxicity as a critical differential diagnosis in patients presenting with neurological symptoms.
- Rapid regression of clinical, CSF, and MRI findings upon sulfasalazine discontinuation underscores its causative role.
- Clinicians should maintain a high index of suspicion for sulfasalazine neurotoxicity, especially in patients with rheumatoid arthritis or inflammatory bowel disease.
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