Meningitis associated with sulphasalazine in a patient with Sjogren's syndrome and polyarthritis

Article Abstract:

Sjogren's syndrome is a chronic systemic inflammatory disorder characterized by dryness of mouth, eyes, and other membranes, and by joint inflammation. Some features associated with other autoimmune disorders, in which the immune system attacks the body's own tissues, may also occur. A case is described of a 37-year-old woman who had membrane dryness and low blood levels of autoantibodies, but no joint disease. Two years later, she developed a mild polyarthritis (inflammation involving multiple joints), and blood levels of autoantibodies were higher. Later that year, the arthritis became active, and several different drugs were tried, some ineffective and others causing side effects. Sulphasalazine was started about one year later, since arthritis was still active. Three weeks after starting this therapy, the woman was admitted to the emergency room with a three-day history of headache, nausea, and vomiting and with severe knee and leg pain. The patient had mild neck stiffness, aversion to light, moderate lymph node swelling, and a rash on the trunk and adjacent extremities. Straight leg raising was restricted and painful, a sign of meningitis. Antibiotics were started, with rapid improvement, and sulphasalazine was discontinued. No organism causing the meningitis was identified. Two weeks after discharge, she seemed well, although tired. As joints were painful, sulphasalazine was restarted, and she experienced fever, severe pain, headache, and rash within eight hours. Straight leg raising was painful, and the neck was slightly rigid. Response to antibiotics and painkillers was slow. After review, it was suggested that both episodes of meningitis were caused by a hypersensitivity reaction to sulphasalazine rather than an organism. She improved markedly when steroids were begun and antibiotics were discontinued. She remained well three months after discharge and was taking steroids for the arthritis. The report suggests that as the frequency of sulphasalazine use increases, the possibility of occurrence of meningitis or related nerve toxicity should be considered. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Meningitis, Sulfasalazine

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A case of secondary Sjogren's syndrome with a swollen thigh

Article Abstract:

Routine dental examinations and dental hygiene may be important to the overall health of patients with Sjogren's syndrome associated with rheumatoid arthritis (RA). An elderly patient with Sjogren's syndrome and RA developed a large abscess in the left thigh. Laboratory tests on the pus removed from the abscess indicated an infection by an organism typically found in the mouth called Peptostreptococcus. An examination and X-rays of the patient's mouth revealed gum abscesses and cavities in all five teeth.

Infection, Dental caries, Rheumatoid arthritis, Thigh

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