Vol 8, No 4 (2022)
Case report
Published online: 2022-12-29

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Complications of sulfasalazine therapy in rheumatology practice

Jolanta Osieleniec1, Przemysław Borowy1, Piotr Krawiec1, Bogdan Batko1
Rheumatology Forum 2022;8(4):185-190.


Sulfasalazine is a drug commonly used in rheumatology and gastrology, unfortunately, up to 50% of patients report side effects during therapy. Most of them have a mild course and their significant factor is the genetically determined metabolism of the drug, which leads to the accumulation of the metabolite — sulfapyridine, responsible for toxic symptoms. Serious side effects are less frequent and may have varied pathomechanisms. Usually, they are difficult to recognize because in the early period they can imitate the course of many inflammatory and systemic diseases, therefore their appearance is not immediately associated with the patient’s intake of sulfasalazine, which may delay proper management and be fatal for the patient. This work aimed to present the serious complications that were observed in patients treated with sulfasalazine, i.e. drug rash with eosinophilia and systemic symptoms (DRESS syndrome), febrile neutropenia and severe nephrotic syndrome. Diagnostic and therapeutic difficulties in individual disease entities were discussed.

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