SULFASALAZINE-ASSOCIATED ENCEPHALOPATHY IN A PATIENT WITH CROHNS-DISEASE

We report a case of acute encephalopathy in a patient with Crohn's dis ease who had taken sulfasalazine for 1 month. The development of a tox ic hepatitis and dermatitis prompted interruption of the drug. Four da ys later, neurological symptoms became evident. These included acute m onoparesis of the left arm, the development of stupor and coma, with e ndorotation of both arms and a left Babinski sign. CT and magnetic res onance imaging revealed multiple lesions in the white and gray brain m atter, suggesting diffuse cerebral microangiitis. All cerebrospinal fl uid examinations were negative. Methylprednisolone was given intraveno usly. Complete clinical normalization followed. Neurotoxicity secondar y to sulfasalazine has seldom been reported in the literature. We foun d certain similarities between this case and two previous case reports suggesting a hypersensitivity reaction to sulfasalazine or one of its metabolites. For ethical reasons, no rechallenge was performed.