Sulfasalazine-induced pulmonary infiltrates and Legionella pneumonia

After 2 weeks' treatment with sulfasalazine (SASP) and mesalazine enema, a 32-year-old female with recently diagnosed ulcerative colitis developed bil ateral pulmonary infiltrates with peripheral eosinophilia. Both drugs were discontinued. Ln view of a high-positive antibody titre (1:4096) against Le gionella pneumophila serogroups 1-5, legionnaires' disease was assumed and empirical antilegionella therapy with macrolid antibiotic was started. The patient's condition improved within days. Three months later SASP was given again in view of exacerbation of the inflammatory bowel disease. Three day s after initiation of therapy acute pulmonary symptoms again developed with bilateral, confluent opacities and blood eosinophilia. The abnormalities r esolved completely after the drug was discontinued and prophylactic antibio tic therapy was given. Peripheral lung infiltrates with blood eosinophilia are a rare side effect of SASP therapy. The prognosis of the illness after the drug has been discontinued is generally good, usually with complete rec overy of pulmonary function. The risk factors for sulfasalazine pulmonary t oxicity are not well known. We describe the first case of SASP-induced hype rsensitivity lung disease with simultaneous Legionella pneumophila infectio n.