Relapsing Course of Sulfasalazine-Induced Drug Reaction with Eosinophilia and Systemic Symptoms Complicated by Alopecia Universalis and Vitiligo

    November 2018 in “ Annals of the Academy of Medicine Singapore ”
    Bertrand SY Lian, Inny Busmanis, Haur Yueh Lee
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    TLDR Sulfasalazine can cause severe allergic reactions leading to long-term autoimmune issues like hair loss and skin discoloration.
    A 59-year-old male with rheumatoid arthritis developed a severe case of sulfasalazine-induced DRESS, characterized by a generalized pruritic rash, eosinophilia, renal and hepatic impairment, and CMV reactivation. Despite treatment with corticosteroids and cyclosporine, he experienced intermittent flares and developed alopecia universalis and vitiligo. The alopecia and vitiligo persisted even after the resolution of DRESS, highlighting the potential for long-term autoimmune sequelae following DRESS. This case underscores the importance of monitoring patients for autoimmune complications and viral reactivation even after the initial resolution of DRESS symptoms.
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