Sulfasalazine-induced fulminant hepatic failure and necrotizing pancreatitis

We report the simultaneous development of fulminant hepatic failure and necrotizing pancreatitis in a patient treated with sulfasalazine. The patient had recent onset of ulcerative colitis. A diffuse skin rash and fulminant hepatic failure developed 2-3 wk after initiation of sulfasalazine therapy. An exploratory laparotomy revealed severe necrotizing pancreatitis with phlegmon, in addition to confluent hepatic necrosis. Electron microscopy of the liver was consistent with drug injury. The patient died after 2 months of hospitalization. This is the first reported case of the concurrent development of these complications associated with sulfasalazine hypersensitivity. These potential adverse effects of sulfasalazine should be considered when using this agent.