PANCYTOPENIA SECONDARY TO HEMOPHAGOCYTIC SYNDROME IN RHEUMATOID-ARTHRITIS TREATED WITH METHOTREXATE AND SULFASALAZINE

Hemophagocytic syndrome is an exceptional cause of pancytopenia, Its e tiologies are most commonly viral or bacterial infections, lymphoproli ferative syndromes, acquired or congenital immunodeficiencies. systemi c diseases, or immunomodulatory treatment. We describe a patient with rheumatoid arthritis (RA) treated with methotrexate (MTX), sulfasalazi ne, and low dose corticosteroids, whose case was seriously complicated by the occurrence of acute febrile pancytopenia. The pancytopenia app eared secondary to hemophagocytic syndrome triggered by Escherichia co li septicemia. The evolution was marked by severe aggravation of RA, p robably due to release of cytokines from macrophages (tumor necrosis f actor-alpha, interleukin 6). Reintroduction of MTX (without sulfasalaz ine) resulted in partial remission and there was no reappearance of ne w hematological anomalies after 16 month followup. A knowledge of this syndrome is particularly important, since it mimics drug toxicity and other complications such as lymphoproliferative diseases.