Bone marrow necrosis after treatment with sulphasalazine.

Abstract

Bone marrow necrosis after treatment with sulphasalazineWe describe a patient in whom extensive necrosis of the bone marrow occurred while taking sulphasalazine.Unlike most cases of extensive bone marrow necrosis he made a full recovery. Case historyA 22 year old Jamaican man diagnosed as suffering from ulcerative proctitis was prescribed sulphasalazine 1 g thrice daily and prednisolone enemas.His blood count at the time was normal.Three weeks later he presented to his family practitioner complaining of headache, sore throat, and facial swelling; amoxycillin was prescribed.His condition continued to deteriorate and a generalised rash developed.He was admitted to hospital five days later.Examination showed facial swelling, generalised tender lymphadenopathy, an exfoliative dermatitis, and a tender, enlarged liver.Haemoglobin concentration was 12-6 g/dl, white cell count 12-6 X 109/1, and platelet count 224 x 109/1.The differential white cell count showed only 12% neutrophils and 88% lymphocytes, some of which were atypical.