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Agranulocytosis is a rare but serious adverse effect of sulfasalazine treatment. We present a case of a 51-year-old woman receiving sulfasalazine for inflammatory arthritis presenting with sore throat, fever, lethargy and leucopenia (white cell count 0.9 × 10(9)/L). After 9 days of treatment with filgrastim (granulocyte-colony stimulating factor, G-CSF), her white cell count increased to 77.4 × 10(9)/L. This case highlights the importance of recognising sulfasalazine-induced agranulocytosis and the management of hyperleucocytosis following G-CSF treatment, to prevent harmful sequelae.

Original publication




Journal article


BMJ Case Rep

Publication Date





Agranulocytosis, Anti-Inflammatory Agents, Non-Steroidal, Arthritis, Female, Filgrastim, Granulocyte Colony-Stimulating Factor, Humans, Leukocyte Count, Leukocytosis, Middle Aged, Sulfasalazine