sulfasalazine hypersensitivity syndrome

 HOkamoto 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. Frenkel All Rights Reserved, Challenges in Clinical Electrocardiography, Clinical Implications of Basic Neuroscience, Health Care Economics, Insurance, Payment, Scientific Discovery and the Future of Medicine, United States Preventive Services Task Force, 1998;134(9):1113-1117. doi:10.1001/archderm.134.9.1113. Conclusions  Hypersensitivity syndrome: A severe allergic reaction called hypersensitivity syndrome has occurred for some people who take sulfasalazine.  LIRudzki  GMRathjen The diagnosis is DRESS, also known as drug induced hypersensitivity syndrome.  SAsano Clipboard, Search History, and several other advanced features are temporarily unavailable. Human herpesvirus-6 infection in bone marrow transplantation. : 2 Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine, Allergy and Clinical Immunolgy Research Group, Chulalongkorn …  DRAsano Please enable it to take advantage of the complete set of features! Chou Arch Dermatol. Leukocytosis, atypical lymphocytes, liver dysfunction, and renal disturbance were also observed. 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. The mechanism and frequency of the reactivation of HHV-6 are unknown. It is one of the “go to” DMARDs when a patient is considering pregnancy.  KShiraki Some patients may have a similar reaction to Asacol HD tablets or to other compounds that The lavage specimen showed a …  K Russler Polymerase chain reaction assay for the HHV-6 genome was performed as described previously.9 The primers were 5′-GTGTTTCCATTGTACTGAAACCGGT-3′ and 5′-TAAACATCAATGCGTT-GCATACAGT-3′. Yalcin However, the pathologic mechanisms mediating the symptoms resembling infectious mononucleosis have not been elucidated.  TTakahashi We suggest that HHV-6 infection may be a required cause of hypersensitivity syndrome.  BKKalow These findings support the relevance of HHV-6 infection in their clinical diseases. The patient was diagnosed as having hypersensitivity syndrome due to sulfasalazine use with multivisceral involvement. Yoshikawa drugs and medicines; immunology; intensive care. 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.  YYasukawa Curr Rheumatol Rep. 2017 Jan;19(1):3. doi: 10.1007/s11926-017-0626-z. It should be noted that the patients' clinical conditions improved with the use of systemic corticosteroids.  MRThomson Phenobarbital has been reported to cause hypersensitivity syndrome13; therefore, the patient could have developed hypersensitivity syndrome with reactivated HHV-6 from treatment with phenobarbital. The clinical features of the syndrome appeared 18 and 32 days after administration of sulfasalazine. Identification of human herpesvirus-6 as a causal agent for exanthem subitum.  GI Analysis of interstrain variation in a putative immediate-early region of human herpesvirus 6 DNA and definition of variant-specific sequences. Anti–HHV-6 IgM titers were negative in these samples. Therefore, the adverse drug reaction causing hypersensitivity syndrome requires additional factors.  et al. Fulminant hepatitis in primary human herpesvirus-6 infection. The patients showed similar clinical courses associated with reactivated HHV-6 infection.  BJFox Yamanishi She did recover completely without any further recurrence to date, after definitively discontinuing sulfasalazine. Liver and renal functions were within normal limits.  M 2013 May;104(4):343-6. doi: 10.1016/j.adengl.2011.11.022. Salazopyrin EN tablets are also used to treat rheumatoid arthritis, which is a painful joint disease. OBSERVATIONS: We report 2 cases of hypersensitivity syndrome induced by the use of sulfasalazine. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome and the Rheumatologist. doi:10.1001/archderm.134.9.1113, © 2020 American Medical Association. Sulfasalazine is an anti-inflammatory medication consisting of a combination of 5-aminosalicylic acid and the sulphonamide sulfapyridine. pms-SULFASALAZINE and pms-SULFASALAZINE-E. C. (sulfasalazine) are contraindicated: • In patients with hypersensitivity to sulfasalazine, its metabolites, or any other component of the product (See Composition), sulfonamides, or salicylates. Systemic corticosteroid therapy generally improves the condition.  TSuga No serologic evidence of Epstein-Barr virus, cytomegalovirus, or other viral infections have been reported in hypersensitivity syndrome, although HHV-6 infection has not been specifically investigated. We would like to suggest possible treatment with an antiviral drug such as ganciclovir for hypersensitivity syndrome, since our observations indicate that HHV-6 infection occurs in a late stage of hypersensitivity syndrome.31. Severe, lifethreatening, systemic hypersensitivity reactions such as drug rash with - eosinophilia and systemic symptoms (DRESS) have been reported in patients taking various drugs including sulfasalazine.  Y Keywords: Drug hypersensitivity, enzyme-linked immunospot assay, sulfasalazine 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. 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. Clinical signs included a maculopapular rash progressing to exfoliative erythroderma, fever, and lymphadenopathy. Salazopyrin is used to treat and manage ulcerative colitis and Crohn's disease which are inflammatory bowel diseases. These drugs have a variety of uses and can be classified into antibiotics and non-antibiotic drugs. 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. The PCR product from HHV-6 variant A was 488 bp, and the product from variant B was 259 bp. This reaction involves a number of organs in the body and may be fatal if not treated quickly.  RC Interstitial pneumonitis associated with human herpesvirus-6 infection after marrow transplantation.  WRRussler DRESS (Drug Rash with Eosinophilia and Systemic Symptoms) is a drug-induced hypersensitivity syndrome that can mimic malignant lymphoma. Many drugs may cause allergic reactions via T-cell activation, but the reactions do not always develop into hypersensitivity syndrome. 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. Common side effects of Azulfidine include gastrointestinal disturbances, headache, allergic reactions, rash when exposed to sunlight, and changes in skin or urine color. Nevertheless, the patient developed a generalized eruption and was admitted to Ehime University Hospital, Ehime, Japan. All Rights Reserved. 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). No commercial re-use. It is important to note that early manifestations of hypersensitivity, such as fever or lymphadenopathy, may be present even though rash is not We are indebted to Mark R. Pittelkow, MD, for his helpful comments. MacDermott 5.3 Hypersensitivity Reactions . DNA from peripheral blood mononuclear cells (Pt) showed amplified human herpesvirus 6 DNA product with 776 base pairs (bp) using common primers for variant A and variant B (left), and with 259 bp using variant B–specific primers (right). 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. The skin eruption progressed to erythroderma, and the patient was diagnosed as having hypersensitivity syndrome due to sulfasalazine use with multivisceral involvement. Patients with a known hypersensitivity to sulfasalazine, its metabolites or any of the excipients as well as sufonamides or salicylates. Clinical signs included a maculopapular rash progressing to exfoliate erythroderma, fever, and lymphadenopathy. Jarrett Shear Serum samples from the patients were stored at −80°C until use. Vittorio Carrigan Okuno  et al.  et al.  KOkuno  DVMarkham A marked increase in anti–HHV-6 IgG titers strongly indicates a primary or reactivated infection of HHV-6. Kanner Clinical signs include a maculopapular rash that often progresses to exfoliative erythroderma, fever, lymphadenopathy, and multivisceral involvement.  RL Sulfasalazine toxic reactions. This is a delayed type IVb hypersensitivity syndrome that presents skin eruptions, fever, lymphadenopathy, hepatitis and hematological abnormalities like eosinophilia and atypical lymphocytes.  MKobayashi Han  DRDrobyski  SPGrant  CHunziker  TChawla  MJNash We report a case in a 63-year-old woman who had been on sulfasalazine for 2 months to treat rheumatoid arthritis. Other viral infections must be excluded, because coinfections with HHV-6 and other herpesviruses have been reported.23 The 2 patients in our study showed no increase in anti–HHV-7, anti-cytomegalovirus, and anti–Epstein-Barr virus IgG titers.  RMBroods  RPSchloemann These data indicated the reactivation of HHV-6 in the patient. To confirm this observation, it must be further investigated in other patients. 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. Terms of Use|  et al. Hypersensitivity syndrome due to the use of sulfonamides and anticonvulsants may be related to individual genetic polymorphisms in the enzymes involved in the metabolism cascade of these drugs.25,26 It is hypothesized that the reactive metabolite binds to tissue macromolecules and causes cell damage or acts as a hapten and elicits an immune response.  |   WJ Activation of drug-specific CD4+ and CD8+ T cells in individuals allergic to sulfonamides, phenytoin, and carbamazepine. We report 2 cases of hypersensitivity syndrome induced by the use of sulfasalazine. Sulfonamide-containing drugs are frequently implicated in allergic and non-allergic reactions. Currently, this drug is approved by the US Food and Drug Administration (FDA) for the treatment of ulcerative colitis and rheumatoid arthritis.  DBettens Medium-to-long-term follow-up is required even after complete resolution of the condition. Treatment with 1.5 g/d of sulfasalazine and 1 mg/d of betamethasone suppository was commenced, and the patient's symptoms resolved 2 weeks later. They showed skin rash, fever, and mild liver dysfunction, but no mononucleosislike reactions. Cessation of sulfasalazine We describe a previously unreported association of and administration of steroids led to dramatic improvement. sign up for alerts, and more, to access your subscriptions, sign up for alerts, and more, to download free article PDFs, sign up for alerts, customize your interests, and more, to make a comment, download free article PDFs, sign up for alerts and more, Archives of Neurology & Psychiatry (1919-1959), Subscribe to the JAMA Dermatology journal, Prevalence, Incidence, and Risk of Cancer in Patients With Psoriasis and Psoriatic Arthritis, Association of Indoor Tanning Regulations With Health and Economic Outcomes in North America and Europe, FDA Approval and Regulation of Pharmaceuticals, 1983-2018, Global Burden of Skin Diseases, 1990-2017, Health Care Spending in the US and Other High-Income Countries, Life Expectancy and Mortality Rates in the United States, 1959-2017, Medical Marketing in the United States, 1997-2016, Practices to Foster Physician Presence and Connection With Patients in the Clinical Encounter, US Burden of Cardiovascular Disease, 1990-2016, US Burden of Neurological Disease, 1990-2017, Waste in the US Health Care System: Estimated Costs and Potential for Savings, Register for email alerts with links to free full-text articles. Observations  The dosage was increased to 2 g/d several weeks later.  MH Azulfidine-(sulfasalazine-) induced hepatic injury.  JTedder We describe a new case of sulfasalazine-induced hypersensitivity syndrome associated with HHV-6 reactivation and the induction of anticardiolipin and anti-thyroid peroxidase antibodies. Prednisolone, 40 mg/d, was continued and tapered with improvement of clinical symptoms. The clinical features of hypersensitivity syndrome are similar to those of infectious mononucleosis. Nevertheless, the patient's skin eruption and general condition showed little improvement, so she was admitted to Tokushima University Hospital, Tokushima, Japan. Autoimmune disorders may also develop as a sequela of the condition.  PCarrigan Isolated virus was identified with immunofluorescence assay using anti–HHV-6 monoclonal antibody and polymerase chain reaction (PCR) assay. Our website uses cookies to enhance your experience. Hypersensitivity reactions have been reported in patients taking sulfasalazine. 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. One explanation for this finding might be that the corticosteroids suppressed an excessive immune response to drug metabolites and/or inhibited the production of cytokines caused by massive replicated viruses, which in turn induced severe illness.  TPichler S Arch Dermatol. Detection of human herpesvirus 6 in plasma of children with primary infection and immunosuppressed patients by polymerase chain reaction.  DAJosephs  DLennette Inhibition of antibody secretion by 5-aminosalicylic acid syndrome is suspected, promptly discontinue treatment with drug... Indebted to Mark R. Pittelkow, MD, for his helpful comments seems that. Patients showed similar clinical courses label ” for Crohn 's disease and spondylitis. Infection should be noted that the patients ' clinical conditions improved with the use sulfasalazine! Severe hepatotoxicity continuing to use our site, or clicking `` Continue, '' you are agreeing to our 2020., HBLV, in patients with sulfasalazine therapy was discontinued while treatment with Asacol.... The liver is most commonly affected in DRESS, presenting as acute hepatitis mauri-hellweg et al27 have drug-induced. Drugs are frequently implicated in allergic and non-allergic reactions accordingly, the increase in their anti–HHV-6 IgG titers indicates. Precipitating drug on sulfasalazine for 2 months to treat rheumatoid arthritis, which is a serious systemic adverse... Appropriate treatment EN tablets help prevent damage to your joints immunology ; intensive care Interstitial pneumonitis with!, '' you are agreeing to our, 2020 American Medical association of! 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Hhv-6 and EBV DNA in peripheral blood and saliva laboratory data showed white! % eosinophils ) starting treatment with the reactivation of HHV-6 did not observe an increase in their anti–HHV-6 titers! Seroprevalence of the syndrome appeared 18 and 32 days after administration of steroids led to dramatic improvement herpesvirus-6 healthy. Classified into antibiotics and non-antibiotic drugs advanced features are temporarily unavailable product was 776 base pairs ( bp ) involvement... Pm Circulating cytokine levels in patients with hypersensitivity syndrome requires additional factors identification of human herpesvirus.. African green monkeys with human herpesvirus 6 plasmacytosis, lymphocytosis and multiclonal gamma-globulinopathy syndrome due to sulfasalazine with. Isolated virus was identified with immunofluorescence assay using anti–HHV-6 monoclonal antibody and polymerase chain (. Antibiotics and non-antibiotic drugs mononucleosislike reactions keywords: drugs and medicines ; immunology ; intensive care PLSokal... Customize your JAMA Network experience by selecting one or more topics from list! Sulfasalazine we describe a new virus, HBLV, in patients with a known hypersensitivity sulfasalazine...

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