Drug Induced Exanthem Secondary to Sulfasalazine: A Case Report

Introduction: Adverse drug reactions are a challenge in modern healthcare. With the increasing complexity of therapeutics, and rising multi-morbidity, it is worth emphasizing the importance of pharmacovigilance and rationale pharmacotherapy. Drug hypersensitivity syndrome (DHS) induced by Sulfasalazine is a serious systemic delayed adverse drug reaction, which is associated with significant morbidity and mortality. Patient concerns: A 42-year-old women who was a known case of Chronic Hypertension and Type 2 Diabetes Mellitus was hospitalised in Dermatology ward of Silchar Medical College and Hospital for developing erythematous macules, patches and papule all over face, both forearms, hands, palms and soles, 10 days after taking sulfasalazine for treatment of knee pain.  Diagnosis: The patient was diagnosed with drug induced exanthem secondary to sulfasalazine based on her drug history, clinical manifestations, and laboratory test results. Interventions: The patient was administered intravenous glucocorticoids. The patient’s condition improved after treatment with IM Pheniramine and antihistaminics. Outcomes: After receiving combination therapy of glucocorticoid with antihistaminics, IM pheniramine and calamine lotion the whole-body pruritus and erythematous rashes disappeared, and no new rash appeared. Conclusion: Despite the significant amount of data on sulfasalazine-induced drug exanthem, due to the diversity in its clinical presentation, proper diagnostic criteria and management protocol have not been well described and physicians rely on case reports majorly for in-depth understanding of this hypersensitivity reaction hence, here, a case report on drug induced exanthem secondary to sulfasalazine has been presented.