Liu Ya, Wang Danxia, Wu Shiwei, Liu Xiang, Xiao Can
Department of Clinical Pharmacy, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), Xiangtan, China.
Department of Pharmacy, People's Hospital of Ningxiang City, Hunan University of Chinese Medicine, Changsha, China.
Front Pharmacol. 2024 Dec 2;15:1488483. doi: 10.3389/fphar.2024.1488483. eCollection 2024.
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.
We gathered relevant literature on SSZ-induced DRESS/DIHS published from 1 January 2005, to 21 July 2024, by searching both English and Chinese databases.
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.
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.
柳氮磺胺吡啶（SSZ）常用于治疗溃疡性结肠炎、类风湿性关节炎和强直性脊柱炎。然而，它也可能引发一种严重的药物反应，即药物性嗜酸性粒细胞增多伴全身症状（DRESS）或药物诱导的超敏反应综合征（DIHS）。本文旨在分析SSZ诱导的DRESS/DIHS的临床特征，并为临床诊断、治疗和预防提供依据。
通过检索英文和中文数据库，我们收集了2005年1月1日至2024年7月21日发表的关于SSZ诱导的DRESS/DIHS的相关文献。
本研究纳入了39例患者（男性15例，女性24例），中位年龄为47岁（范围：11 - 82岁）。服用SSZ后，DRESS/DIHS的中位发病时间为28天（范围：10 - 60天）。这些患者表现出发热（100%）、皮疹（100%）、消化系统反应（38.5%）和水肿（35.9%）等临床症状。38例患者出现器官受累，常见受累器官为淋巴结（78.9%）、肝脏（94.7%）、肾脏（15.8%）、心脏（13.2%）和肺（7.9%）。所有患者均有血液学异常，主要为嗜酸性粒细胞增多（69.2%）和非典型淋巴细胞增多（35.9%）。其他血液学变化包括粒细胞缺乏症（5.1%）、噬血细胞综合征（5.1%）和全血细胞减少症（2.6%）。21例患者（53.8%）出现病毒再激活。SSZ诱导的DRESS/DIHS的主要治疗方法是立即停用药物，随后给予全身性皮质类固醇治疗。环孢素、静脉注射免疫球蛋白（IVIG）、霉酚酸酯、环磷酰胺和利妥昔单抗等替代治疗方法的疗效尚需进一步研究确定。
SSZ可能导致DRESS/DIHS。为做出明确诊断，医疗保健提供者应通过检查患者的临床表现、进行体格检查和分析实验室检查结果来进行全面评估。建议立即停用SSZ，皮质类固醇通常被认为是治疗DRESS/DIHS的有效方法。
