Glandular fever-like illness associated with sulphasalazine.

A diagnosis of ulcerative colitis was made in a 30year-old Caucasian male and treatment with sulphasalazine 3 g daily in divided doses was started. He was on no other drug treatment. Three weeks later he developed fever, mouth ulceration and a generalized skin rash. Sulphasalazine was stopped and he was referred to hospital. On admission he appeared ill, had a pyrexia of 40'C, multiple large oropharyngeal ulcers, a generalized maculopapular rash with petechiae on the legs, and multiple lymph nodes were palpable in the neck, axillae and inguinal regions. The liver was just palpable but not tender, there were no genital lesions and his chest was clear. His colitis was in remission. Investigations showed a haemoglobin of 15A4 g/dl, a white cell count of 24 x 109/litre, with a differential of 41% neutrophil leucocytes, 2% eosinophils, 5% monocytes and 52% lymphocytes of which 34% were atypical. Liver function tests showed a raised gamma