Fatal massive hepatic necrosis: a probable hypersensitivity reaction to sulfasalazine

Sulfasalazine (salicylazosulfapyridine) is a commonly prescribed oral medication for inflammatory bowel disease. We report a case of a 15-yr-old boy with ulcerative colitis who developed a generalized hypersensitivity reaction with a serum sickness-like syndrome and severe hepatotoxicity while taking sulfasalazine, perphenazine, and amitriptyline. The injury to the liver persisted for 5 months after withdrawal of the drugs, and the patient died of terminal hepatic failure with massive hepatic necrosis. Severe hepatic toxicity to sulfasalazine is uncommon, but it can be fatal.