CASE REPORT - Sulfasalazine-induced hypersensitivity and hemophagocytic syndrome associated with reactivation of Epstein-Barr virus

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Clin Rheumatol. 2007 Oct 19 [Epub ahead of print]

Sulfasalazine-induced hypersensitivity syndrome and hemophagocytic

syndrome associated with reactivation of Epstein-Barr virus.

Komatsuda A, Okamoto Y, Hatakeyama T, Wakui H, Sawada KI.

Third Department of Internal Medicine, Akita University School of

Medicine, 1-1-1 Hondo, Akita, Akita, 010-8543, Japan.

A 58-year-old woman with rheumatoid arthritis (RA) developed fever,

skin eruptions, leukocytopenia, and thrombocytopenia, 3 weeks after

treatment with sulfasalazine. A skin biopsy showed hydropic

degeneration of keratinocytes and lymphocytic infiltrate. A bone

marrow aspiration demonstrated an increased number of macrophages with

hemophagocytosis. Although serologic tests for Epstein-Barr virus

(EBV) indicated a previous infection, EBV deoxyribonucleic acid was

detected in her serum by polymerase chain reaction. Cessation of

sulfasalazine and administration of steroids led to dramatic

improvement. This case illustrates that the hemophagocytic syndrome

associated with reactivation of EBV can occur as part of drug

hypersensitivity reactions in RA patients taking sulfasalazine.

PMID: 17952482

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed & Cmd=ShowDetailView & TermToSear\

ch=17952482

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