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Title: The 3-week sulphasalazine syndrome strikes again
Authors: Lau, G.
Kwan, C.
Chong, S.M. 
Keywords: Acute myocarditis
Bone marrow necrosis
Massive hepatocellular necrosis
Sero-negative rheumatoid arthritis
Tubulo-interstitial nephritis
Issue Date: 2001
Citation: Lau, G., Kwan, C., Chong, S.M. (2001). The 3-week sulphasalazine syndrome strikes again. Forensic Science International 122 (2-3) : 79-84. ScholarBank@NUS Repository.
Abstract: A 34-year-old lady developed a constellation of dermatitis, fever, lymphadenopathy and hepatitis, beginning on the 17th day of a course of oral sulphasalazine for sero-negative rheumatoid arthritis. Cervical and inguinal lymph node biopsies showed the features of severe necrotising lymphadenitis, associated with erythrophagocytosis and prominent eosinophilic infiltrates, without viral inclusion bodies, suggestive of an adverse drug reaction.A week later, fulminant drug-induced hepatitis, associated with the presence of anti-nuclear autoantibodies (but not with other markers of autoimmunity), and accompanied by multi-organ failure and sepsis, supervened. She subsequently died some 5 weeks after the commencement of her drug therapy.Post-mortem examination showed evidence of massive hepatocellular necrosis, acute hypersensitivity myocarditis, focal acute tubulo-interstitial nephritis and extensive bone marrow necrosis, with no evidence of malignancy. It is thought that the clinico-pathological features and chronology of this case bore the hallmarks of the so-called '3-week sulphasalazine syndrome', a rare, but often fatal, immunoallergic reaction to sulphasalazine. Copyright © 2001 Elsevier Science Ireland Ltd.
Source Title: Forensic Science International
ISSN: 03790738
DOI: 10.1016/S0379-0738(01)00476-5
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