Hepatotoxicity after treatment with sulfasalazine

Abstract

A 42-year-old man with fever, right lower quadrant abdominal pain, and occasional rectal bleeding was diagnosed as having Crohn's disease. He was started on sulfasalazine (Azulfidine) therapy, and a generalized rash subsequently developed. When laboratory data indicated possible sulfasalazine hepatotoxicity, use of the drug was discontinued. Symptoms continued to worsen, however, and the patient died of fulminant hepatic necrosis. Comparison with similar cases showed that a hypersensitivity reaction was probably responsible for the liver damage, with a latent period that made recognition difficult. Thus, while fulminant hepatic necrosis is rare, this possibility must always be considered by the clinician when prescribing and monitoring therapy with sulfasalazine.