# Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) Syndrome Following Initiation of Sulfasalazine for Ulcerative Colitis: A Yearlong Clinical Challenge

## TL;DR

A patient with ulcerative colitis developed a rare drug reaction called DRESS syndrome after taking sulfasalazine, requiring long-term treatment and multidisciplinary care.

## Contribution

This case highlights the rare but severe complication of DRESS syndrome with sulfasalazine and the use of IVIG in managing long-term treatment resistance.

## Key findings

- Sulfasalazine can cause DRESS syndrome, leading to severe flare of ulcerative colitis and acute liver injury.
- Treatment with high-dose steroids and cyclosporine resolved initial symptoms but left treatment-resistant dermatologic and thyroid issues.
- IVIG successfully helped reduce reliance on steroids and cyclosporine after a year of therapy.

## Abstract

Sulfasalazine, a commonly prescribed medication for treating ulcerative colitis, can cause a severe yet rare adverse drug reaction known as drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. In this case, a female patient experienced a severe flare of her ulcerative colitis, accompanied by sulfasalazine-induced DRESS syndrome. The ulcerative colitis flare and acute liver injury resolved with a treatment regimen of high-dose steroids and cyclosporine. However, she continued to have treatment-resistant dermatologic changes and delayed organ involvement, including the development of hyperthyroidism that required close multidisciplinary follow-up. IVIG was used to successfully wean steroids and cyclosporine after a year of therapy.