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Example sentences for: discontinuation
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In cases of fulminant hepatic failure and agranulocytosis, several patients have died despite the use of steroids [ 27 28 37 ] . Intravenous immunoglobulin was reported as a successful "rescue" therapy in a patient with SSZ induced fulminant hepatic failure and erythroid hypoplasia who had not responded to steroids [ 25 ] . Due to the infrequent occurrence of severe SSZ toxicity that does not improve with drug discontinuation, it is unlikely that randomized controlled trials of steroids or other interventions will be performed.
Lymphocyte proliferative response to recombinant HIV-1 p24 protein had to exceed a stimulation index of ten before treatment discontinuation, and net counts per minute had to be 800 or greater.
Sulfasalazine (SSZ) is a widely used and highly effective anti-inflammatory agent in the treatment of Crohn's disease and ulcerative colitis [ 1 2 3 ] . SSZ is also being used with increasing frequency in the treatment of various rheumatolgical disorders [ 4 5 6 7 ] . SSZ is preferred over other agents such as gold and penicillamine in rheumatology patients due to its more favorable side effect profile [ 8 9 10 ] . Nonetheless, rash, fever, and dyspepsia occur in 3% to 20% of treated patients [ 7 11 12 ] . These reactions are usually dose dependent and improve with dose reduction or discontinuation [ 7 12 ] . However, more serious but less common side effects have also been reported [ 13 14 15 16 17 18 19 ] . We now report a severe systemic reaction to SSZ in a 21-year-old female with rheumatoid arthritis characterized by granulomatous infiltration of the bone marrow, colon and small bowel as well as cholestatic hepatitis and seizures.
SSZ has previously been associated with neutropenia with an estimated incidence of 0.04% during the first 30 days of treatment [ 34 ] . Bone marrow biopsy specimens of patients with SSZ induced agranulocytosis reveal a paucity of myeloid cells but full recovery typically occurs within 10 days of drug discontinuation [ 35 36 37 ] . Although our patient had adequate myeloid cells in her bone marrow biopsy, she developed absolute neutropenia by hospital day #19 that improved with steroid therapy.
The anti-inflammatory activity of SSZ is due to the 5-aminosalicylic acid component while the majority of the adverse side effects have been attributed to the sulfapyridine moiety [ 14 15 16 ] . Fever, abdominal pain, and rash may develop in 3% to 20% of treated patients, but these side effects are usually mild and improve with dose reduction [ 7 11 12 ] . Severe side effects necessitating SSZ discontinuation occur in less than 5% of treated patients [ 11 ] .
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