Abstract
Introduction
A drug reaction with eosinophilia and systemic symptom (DRESS) is a severe and rare adverse-drug hypersensitivity syndrome. The evolution of DRESS is unpredictable and haematological abnormalities may occur in 50 % of cases. Sulfasalazine (SSZ) is rarely associated with DRESS. Agranulocytosis is a rare but recognized side-effect to SSZ. Both DRESS and agranulocytosis were not reported previously with SSZ.
Case summary
We report a case of SSZ-induced DRESS followed by severe agranulocytosis occurring in a 25-year-old man. The patient’s general condition and laboratory tests gradually improved after the administration of granulocyte colony-stimulating factor (GCSF).
Discussion
In our patient, the co-occurrence of DRESS and agranulocytosis is unlikely to be coincidental. Immunological mechanisms may play an important role in drug associated agranulocytosis in patients presenting DRESS. According to the Naranjo’s algorithm the likelihood that our patient’s DRESS and agranulocytosis occurred as a result of therapy with SSZ is probable. G-CSF was found to be useful in shortening the duration of granulocyte recovery in drug-induced agranulocytosis.
Conclusion
Careful monitoring of neutrophil counts is required on SSZ therapy as well as in the course of DRESS.
This is a preview of subscription content, log in via an institution to check access.
References
Walsh SA, Creamer D. Drug reaction with eosinophilia and systemic symptoms (DRESS): a clinical update and review of current thinking. Clin Exp Dermatol. 2011;36(1):6–11.
Teo L, Tan E. Sulphasalazine-induced DRESS. Singap Med J. 2006;47(3):237–9.
Cacoub P, Musette P, Descamps V, Meyer O, Speirs C, Finzi L, et al. The DRESS syndrome: a literature review. Am J Med. 2011;124(7):588–97.
Komatsuda A, Okamoto Y, Hatakeyama T, Wakui H, Sawada K. Sulfasalazine-induced hypersensitivity syndrome and hemophagocytic syndrome associated with reactivation of Epstein-Barr virus. Clin Rheumatol. 2008;27(3):395–7.
Tesfa D, Keisu M, Palmblad J. Idiosyncratic drug-induced agranulocytosis: possible mechanisms and management. Am J Hematol. 2009;84(7):428–34.
Jick H, Myers MW, Dean AD. The risk of sulfasalazine- and mesalazine-associated blood disorders. Pharmacotherapy. 1995;15(2):176–81.
Cochrane P, Atkins P, Ehsanullah S. Agranulocytosis associated with sulphasalazine therapy. Postgrad Med J. 1973;49(575):669–72.
Kano Y, Shiohara T. The variable clinical picture of drug-induced hypersensitivity syndrome/drug rash with eosinophilia and systemic symptoms in relation to the eliciting drug. Immunol Allergy Clin N Am. 2009;29:481–501.
Aquino RT, Vergueiro CS, Magliari ME, de Freitas TH. Sulfasalazine-induced DRESS syndrome (drug rash with eosinophilia and systemic symptoms). Sao Paulo Med J. 2008;126(4):225–6.
Ibáñez L, Sabaté M, Ballarín E, Puig R, Vidal X, Laporte JR. Use of granulocyte colony-stimulating factor (G-CSF) and outcome in patients with non-chemotherapy agranulocytosis. Pharmacoepidemiol Drug Saf. 2008;17:224–8.
Funding
None.
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Fathallah, N., Slim, R., Rached, S. et al. Sulfasalazine-induced DRESS and severe agranulocytosis successfully treated by granulocyte colony-stimulating factor. Int J Clin Pharm 37, 563–565 (2015). https://doi.org/10.1007/s11096-015-0107-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11096-015-0107-2