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ORIGINAL RESEARCH article

Front. Pharmacol.
Sec. Drugs Outcomes Research and Policies
Volume 15 - 2024 | doi: 10.3389/fphar.2024.1488483

Literature review of the clinical features of sulfasalazine-induced drug reaction with eosinophilia and systemic symptoms/drug-induced hypersensitivity syndrome (DRESS/DIHS)

Provisionally accepted
Ya Liu Ya Liu 1Danxia Wang Danxia Wang 2Shiwei Wu Shiwei Wu 1Xiang Liu Xiang Liu 1Can Xiao Can Xiao 1*
  • 1 The Affiliated Hospital of Hunan University, Xiangtan, China
  • 2 People's Hospital of Ningxiang City, Hunan University of Chinese Medicine, Changsha, China

The final, formatted version of the article will be published soon.

    Background: Sulfasalazine (SSZ) is commonly prescribed for the treatment of ulcerative colitis, rheumatoid arthritis, and ankylosing spondylitis. However, it can also trigger a severe drug reaction known as Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) or Drug-Induced Hypersensitivity Syndrome (DIHS). This article aims to analyze the clinical characteristics of DRESS/DIHS induced by SSZ and provide evidence for clinical diagnosis, treatment, and prevention. Methods: We gathered relevant literature on SSZ-induced DRESS/DIHS published from January 1, 2005, to July 21, 2024, by searching both English and Chinese databases. Results: Thirty-nine patients (15 males and 24 females) were included in the study, with a median age of 47 years (range: 11-82 years). Following SSZ administration, the median onset time of DRESS/DIHS was 28 days (range: 10-60 days). These patients exhibited clinical symptoms such as fever (100%), rash (100%), digestive system responses (38.5%), and edema (35.9%). Organ involvement was observed in 38 patients, with commonly affected organs being lymph nodes (78.9%), liver (94.7%), kidney (15.8%), heart (13.2%), and lung (7.9%). All patients had hematological abnormalities, primarily eosinophilia (69.2%) and atypical lymphocytosis (35.9%). Additional hematological changes included agranulocytosis (5.1%), hemophagocytic syndrome (5.1%), and pancytopenia (2.6%). Virus reactivation occurred in 21 patients (53.8%). The primary treatment for DRESS/DIHS due to SSZ is the immediate cessation of the drug, followed by systemic corticosteroid administration. Alternative treatments such as cyclosporine, intravenous immunoglobulin (IVIG), mycophenolate mofetil, cyclophosphamide, and rituximab require further investigation to establish their efficacy. Conclusion: SSZ may lead to DRESS/DIHS. To make a conclusive diagnosis, healthcare providers should conduct a thorough assessment by examining the patient’s clinical presentation, conducting physical evaluations, and analyzing laboratory findings. Immediate discontinuation of SSZ is recommended, and corticosteroids are often considered an efficacious treatment for DRESS/DIHS.

    Keywords: Sulfasalazine, drug reaction with eosinophilia and systemic symptoms (DRESS), Drug-induced hypersensitivity syndrome (DIHS), HHV-6 reactivation, diagnosis

    Received: 30 Aug 2024; Accepted: 18 Nov 2024.

    Copyright: © 2024 Liu, Wang, Wu, Liu and Xiao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Can Xiao, The Affiliated Hospital of Hunan University, Xiangtan, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.