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sulfasalazine hypersensitivity syndrome

Sulfasalazine has been reported to modulate the immune response by inhibiting the secretion of IgA and the production of interleukin 1 and tumor necrosis factor α.29,30 These effects of sulfasalazine on the immune system may facilitate the reactivation of HHV-6 by activated T cells and induce the constellation of symptoms and signs of hypersensitivity syndrome. 5.3 Hypersensitivity Reactions . S Arch Dermatol.  MJNash  et al. Therefore, sulfasalazine is contraindicated in patients with sulfasalazine hypersensitivity, salicylate hypersensitivity, sulfonamide hypersensitivity, and 5-aminosalicylates hypersensitivity. HHS  RMBroods We describe 2 patients who experienced the sudden onset of severe infectious mononucleosislike illness 18 and 32 days after the initiation of therapy with sulfasalazine.  DALaurent We are indebted to Mark R. Pittelkow, MD, for his helpful comments. Yoshikawa  RFClark They showed skin rash, fever, and mild liver dysfunction, but no mononucleosislike reactions.  CCMuglia In conclusion, we demonstrate that a drug-induced hypersensitivity syndrome due to sulfasalazine use is associated with reactivation of HHV-6 and an infectious mononucleosislike illness. A severe adverse reaction to sulfasalazine therapy has been associated with hypersensitivity syndrome, the clinical features of which are similar to infectious mononucleosis. Sulfasalazine has also been used for some skin conditions. Mihas Betamethasone therapy was discontinued while treatment with sulfasalazine was increased to 2 g/d. In this report, a case of sulfasalazine- induced DRESS syndrome (the acronym for Drug Rash with Eosinophilia and Systemic Symptoms) is described. Get free access to newly published articles. Russler The diagnosis is DRESS, also known as drug induced hypersensitivity syndrome. The clinical features of the syndrome appeared 18 and 32 days after administration of sulfasalazine. Salazopyrin EN tablets help prevent damage to your joints. Genotyping of HHV-6 was performed as described previously.10 Human herpesvirus 6 DNA was amplified using a triple primer mix of 5′-CAGAAGTG-CCAGGGAAATCC-3′, 5′-TTATCGGGGCTGTAAGCCAA-3′, and 5′-TTTGCT-TCCCGGAGTCATAGA-3′.  MH Azulfidine-(sulfasalazine-) induced hepatic injury. A skin biopsy specimen obtained from the upper portion of the patient's right arm showed lymphocytic infiltration in the epidermis with necrotic keratinocytes, partial liquefaction degeneration of basal cells, and perivascular lymphocytic infiltration in the dermis (Figure 2). Our website uses cookies to enhance your experience. A 22-year-old Japanese woman who presented with abdominal pain and bloody diarrhea was diagnosed as having ulcerative colitis. Results from a physical examination revealed a high fever (body temperature, 39.7°C), tonsillar pharyngitis, bilateral cervical lymphadenopathy, and hepatosplenomegaly. It has also been used “off label” for Crohn's disease and ankylosing spondylitis. Systemic corticosteroid therapy generally improves the condition. Conclusions: Two cases of hypersensitivity syndrome due to sulfasalazine use were associated with the reacti-vation of human herpesvirus 6, which may be a re-quired cause of hypersensitivity syndrome. Liver and renal functions were within normal limits. This observation suggests active replication of the virus after the initiation of clinical symptoms. Clinical signs included a maculopapular rash progressing to exfoliative erythroderma, fever, and lymphadenopathy.  GI Analysis of interstrain variation in a putative immediate-early region of human herpesvirus 6 DNA and definition of variant-specific sequences. Keywords: Drug hypersensitivity, enzyme-linked immunospot assay, sulfasalazine We report 2 cases of hypersensitivity syndrome induced by the use of sulfasalazine. Isolation of a new virus, HBLV, in patients with lymphoproliferative disorders. Here, we report the first case, to our knowledge, of a patient with previously unidentified SIHS who developed a significantly more rapid and extreme recurrence on re-exposure to sulfasalazine. Yamakado S, Yoshida Y, Yamada T, Kishida T, Kobayashi M, Nomura T. Intern Med. Then, HHV-6 latently infects monocytes and salivary glands. 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Epub 2013 Apr 4.  RC Interstitial pneumonitis associated with human herpesvirus-6 infection after marrow transplantation. Privacy Policy| However, 1 of the 3 patients described by Sumiyoshi et al6 had been treated with phenobarbital for 3 weeks prior to onset of the illness, and peripheral blood eosinophilia had been found on admission (Y. Sumiyoshi, written communication, June 1997). Levy Sulfasalazine is considered to be generally safer than other DMARDS such as MTX and Leflunomide.  KBalachandra Yakushijin © BMJ Publishing Group Limited 2020. This reaction involves a number of organs in the body and may be fatal if not treated quickly. Sulfasalazine Sulfasalazine 2013-01-18 00:00:00 Reactions 723 - 17 Oct 1998 Hypersensitivity syndrome associated with reactivation of human herpesvirus 6: 2 case reports Sulfasalazine-induced hypersensitivity syndrome was associated with the reactivation of human herpesvirus 6 (HHV-6) in 2 patients. Anti–HHV-6 IgM titers were negative in these samples. 1998;134(9):1113–1117.  et al.  THigashi Fulminant hepatitis in primary human herpesvirus-6 infection.  GMRathjen A 29-year-old Japanese man with an 8-year history of psoriatic arthritis had been treated with numerous agents, including loxoprofen, cyclosporine, and prednisolone, which moderately controlled the disease. Facial edema was also present. We report 2 cases of sulfasalazine-induced severe hypersensitivity syndrome associated with the reactivation of HHV-6. Z Rheumatol.  SZAblashi Pulmonary infiltration and eosinophilia associated with sulfasalazine therapy for ulcerative colitis: a case report and review of literature. Okuno  TTakahashi No serologic evidence of viral infections has been reported with this syndrome; however, human herpesvirus 6 infection has not been specifically investigated, which could cause an infectious mononucleosislike syndrome. Sulfasalazine is an anti-inflammatory medication consisting of a combination of 5-aminosalicylic acid and the sulphonamide sulfapyridine. We believe these cases represent hypersensitivity syndrome due to sulfasalazine therapy. Recently, a severe infectious mononucleosislike syndrome was reported to be caused by human herpesvirus 6 (HHV-6) infection in immunocompetent adults.5-7 Its clinical features are characterized by skin rash, generalized lymphadenopathy, high fever, liver dysfunction, leukocytosis, and atypical lymphocytosis. Sulfasalazine is contraindicated in patients with porphyria, urinary or intestinal obstruction, and hypersensitivity to sulfasalazine, its metabolites, sulfonamides, or salicylates. Recently, a severe infectious mononucleosislike syndrome caused by HHV-6 infection was reported in immunocompetent adults.5-7 Clinical signs included high fever, skin rash, generalized lymphadenopathy, liver dysfunction, and leukocytosis with the appearance of atypical lymphocytes.  ECKatsafanas  FJKalser  et al. The patient's skin was covered with erythematous macules and papules and scattered petechiae. M indicates the molecular weight standard marker; P, positive control; and N, umbilical cord-blood mononuclear cells (negative control). Vittorio  MF Thirty-two days after treatment with sulfasalazine was initiated, the patient developed a sore throat, nausea, vomiting, diarrhea, and high fever.  SPGrant Effects on folic acid. A Case of Sulfasalazine-Induced Hypersensitivity Syndrome Confirmed by Enzyme-Linked Immunospot Assay Parkpoom Phatharacharukul, 1 and Jettanong Klaewsongkram 2 1 Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. To exclude the possibility that the adverse drug reaction was nonspecifically associated with HHV-6 reactivation, we investigated 4 patients who developed adverse drug reactions due to oral administration of phenytoin, allopurinol, and acetaminophen. Observations  Two cases of hypersensitivity syndrome due to sulfasalazine use were associated with the reactivation of human herpesvirus 6, which may be a required cause of hypersensitivity syndrome. Yamanishi Keywords: The symptoms are often progressive for several weeks after treatment with the drug is discontinued. We did not observe an increase in their anti–HHV-6 IgG titers throughout their clinical courses. Eosinophilia, atypical lymphocytosis, liver dysfunction, and renal disturbance are also frequently observed with this syndrome.  SKTapper However, these proposed pathomechanisms do not fully explain the phenomenon of hypersensitivity syndrome, which is induced by only a select group of medications.  KTakeshita Medium-to-long-term follow-up is required even after complete resolution of the condition.  K In 1 patient, human herpesvirus 6 variant B was isolated from peripheral blood mononuclear cells, and in both patients anti–human herpesvirus 6 IgG titers increased considerably. : 2 Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine, Allergy and Clinical Immunolgy Research Group, Chulalongkorn … Findings from a microscopic examination of a skin lesion on the upper portion of the right arm of patient 1 shows infiltration of lymphocytic cells in the epidermis with necrotic keratinocytes, partial liquefaction degeneration of basal cells, and perivascular infiltration of lymphocytic cells in the dermis (hematoxylin-eosin, original magnification ×100). Furthermore, an anti–HHV-6 IgG titer of 1:160 two days before admission and on the 6th hospital day increased to 1:1280 on the 16th day and 1:5120 on the 22nd day. Salazopyrin is used to treat and manage ulcerative colitis and Crohn's disease which are inflammatory bowel diseases. [DRESS syndrome following sulfasalazine treatment]. Sulfasalazine therapy was discontinued 4 days later.  JTedder  DJSlaughter Hernández N, Borrego L, Soler E, Hernández J. Actas Dermosifiliogr.  NSchirmer Several methods may be used to confirm HHV-6 infection, including measurement of anti–HHV-6 titers, PCR analysis, and isolation of HHV-6.  et al. Accordingly, the reactivation of HHV-6 did not result from coinfection with these viruses. Although the 3 reported cases were described as primary HHV-6 infection, the possibility of reactivated HHV-6 could not be excluded because of an absent or low anti–HHV-6 IgM response.24 If the infectious mononucleosislike syndrome was precipitated by reactivated HHV-6 infection, possible causes of the reactivation were not delineated. This case demonstrates the importance of recognising SIHS early in patients to prevent re-exposure to sulfasalazine and to ensure timely initiation of appropriate treatment. Severe infectious mononucleosis-like syndrome and primary human herpesvirus 6 infection in an adult. To confirm this observation, it must be further investigated in other patients.  MEizuru Results from a physical examination revealed tender generalized lymphadenopathy. Seroconversion to human herpesvirus 6 following liver transplantation is a marker of cytomegalovirus disease. Common side effects of Azulfidine include gastrointestinal disturbances, headache, allergic reactions, rash when exposed to sunlight, and changes in skin or urine color. 2013 May;104(4):343-6. doi: 10.1016/j.adengl.2011.11.022. Methylprednisolone pulse therapy (1 g/d for 3 days) was administered, and the patient's general condition and liver function improved markedly. 2015 May;63(5):78-9. Tohyama M, Yahata Y, Yasukawa M, et al. Frenkel Cessation of sulfasalazine and administration of steroids led to dramatic improvement. Here, we report the first case, to our knowledge, of a patient with previously unidentified SIHS who developed a significantly more rapid and extreme recurrence on re-exposure to sulfasalazine.  KKAsh Hypersensitivity syndrome: A severe allergic reaction called hypersensitivity syndrome has occurred for some people who take sulfasalazine. Leukocytosis, atypical lymphocytes, liver dysfunction, and renal disturbance were also observed.  MOshima Laboratory data showed a white blood cell count of 14.4 × 109/L (48% lymphocytes and 3% atypical lymphocytes). Treatment with 60 mg/d of oral prednisolone was begun on the patient's ninth day at the hospital and tapered with improvement of clinical symptoms. On the sixth hospital day, results from laboratory studies revealed the following values: aspartate aminotransferase, 755 U/L; alanine aminotransferase, 1058 U/L; lactate dehydrogenase, 1712 U/L; and total bilirubin, 41.04 µmol/L (2.4 mg/dL). Salahuddin  FMauri A generalized maculopapular rash was observed over the patient's face, trunk, and extremities (Figure 1).  JJ Anticonvulsant hypersensitivity syndrome. The period from the onset of a primary symptom to the increase in anti–HHV-6 IgG titer seems too long, although the exact time from onset is unknown for reactivated HHV-6 infection.  GJune These findings support the relevance of HHV-6 infection in their clinical diseases. No serologic evidence of viral infections has been reported with this syndrome; however, human herpesvirus 6 infection has not been specifically investigated, which could cause an infectious mononucleosislike syndrome. From coinfection with these viruses sulfasalazine is an anti-inflammatory medication consisting of a combination of 5-aminosalicylic acid ( )! Courses associated with sulfasalazine hypersensitivity, and the sulphonamide sulfapyridine 's disease and ankylosing spondylitis increase in patient!, 2020 American Medical association skin biopsy specimens of patient 1 using PCR is. 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