Contemporaneous Sulfasalazine-Induced Stevens-Johnson Syndrome and Cholestatic Liver Injury: A Sporadic Case Report

Abstract

Background: Stevens-Johnson syndrome (SJS) and drug-induced liver injury (DILI) are rare but potentially life-threatening adverse drug reactions. Sulfasalazine is known to cause either condition individually, but their simultaneous occurrence is exceedingly rare. Case Presentation: We report the case of a 56-year-old female with psoriatic arthritis who developed a severe hypersensitivity reaction shortly after initiating sulfasalazine. Clinical features included facial erythema, mucosal ulceration, conjunctivitis, and hepatocellular liver injury. Skin biopsy confirmed Stevens-Johnson Syndrome. Laboratory investigations were done to exclude infectious, autoimmune, and metabolic liver causes. Management and Outcome: The patient received dexamethasone, IVIG, and supportive care with a multidisciplinary team. Liver enzymes normalized, mucocutaneous lesions resolved, and the patient was discharged in stable condition. Conclusion: Stevens-Johnson syndrome and idiosyncratic liver injury are rare but established adverse effects of sulfasalazine. Our case highlights the importance of early identification of the offending agent in Stevens-Johnson syndrome and drug-induced liver injury, and the prompt management of the patient’s condition using steroids and other supportive measures such as fluid management. Early recognition, drug discontinuation, and multidisciplinary care are critical to ensuring a favorable outcome.