Sulfasalazine toxic reactions. Hepatitis, fever, and skin rash with hypocomplementemia and immune complexes

Abstract

SINCE its discovery in 1942, sulfasalazine (Azulfidine) has been the most commonly used sulfonamide for the treatment of inflammatory bowel disease. Its merit has been well established in ulcerative colitis, and it possibly has a place in the treatment of Crohn's disease. Although minor adverse effects (anorexia, nausea, vomiting) are recognized frequently, serious reactions are considered rare. In recent years, however, severe adverse reactions to sulfasalazine therapy have been reported with greater frequency.^1,2We report a generalized allergic reaction with fever, skin rash, arthralgias, lymphadenopathy, and hepatitis coincident with the administration of this drug. This reaction was accompanied by decreased complement levels and circulating immune complexes. <h3>Report of a Case</h3> A 26-year-old man was seen because of a three-year history of intermittent cramping abdominal pain, diarrhea, and a 9-kg weight loss. A sigmoidoscopy, small bowel series, and barium enema examination showed Crohn's disease involving the terminal ileum and rectum.