Sulfasalazine-Induced Agranulocytosis: A Case Series and Review of Literature

Sulfasalazine (SSZ) remains a valuable treatment option for Rheumatoid Arthritis (RA), especially in women of childbearing age, and is considered safe in pregnancy and lactation. However, the adverse effects in the form of allergic reactions, rashes, feverishness, and gastrointestinal symptoms are not uncommon and usually resolve on discontinuation of the drug. Despite the potential adverse effects, the occurrences are infrequently reported. Agranulocytosis (ANC < 500 cell/cumm) is a rare complication of SSZ that may be potentially life-threatening. We report two cases of SSZ-induced agranulocytosis after 6 weeks of initiation of treatment for RA despite normal leucocyte counts in the initial phase of treatment. There was complete recovery of the counts following discontinuation, along with the institution of colony-stimulating factors and antibiotics for febrile neutropenia. Notably, Granulocyte Colony-Stimulating Factor (G-CSF) did not produce any adverse effects, and the patients were discharged after their ANC levels returned to normal. It is, therefore, essential to regularly monitor blood counts following the initial treatment.