The main adverse effects of salazopyrin are usually dose-dependant and mild
. Exceptionally, idiosyncratic reactions occur which may be life-threatenin
g.
Case reports. - Two 10-year old children were treated for Crohn's disease w
ith salazopyrin. At day 21 and day 10 respectively, pharyngitis, rash, and
fever were noted. During the following days, high-grade fever persisted, wh
ile jaundice, severe cytolysis and acute liver failure also occurred. Drug
hepatoxicity was suspected and salazopyrin was withdrawn on day 29 and day
24 respectively. Development of hepatic encephalopathy led to urgent liver
transplantation in both cases.
Conclusion. - Salazopyrin is a possible cause of fulminant immunoallergic h
epatis. Prompt therapeutic interruption is urgent, but it may not alter the
outcome and or preclude the need for liver transplantation. We suggest tha
t salazopyrin therapy be avoided in pediatric inflammatory bowel disease wh
enever possible, and that the use of pure amino- salicylates be preferred.
(C) 1999 Elsevier, Paris.