The objectives were to evaluate drug rash with eosinophilia and systemic symptoms syndrome due
to sulfasalazine and to carry out the pharmacoeconomic assessment associated with this adverse
drug reaction (ADR). A 37‑year woman was presented with rashes, fever, cough, and dyspnea.
In the past 3 months, she was on sulfasalazine for inflammatory polyarthritis and seronegative
spondyloarthritis. The diagnosis was based on raised eosinophils count, breathing difficulty, and
typical pattern of rashes. Significant improvement was seen after discontinuation of sulfasalazine
and with the initiation of parenteral corticosteroids. The casualty of this ADR was “probable” based on
RegiSCAR, WHO, and Naranjo casualty assessment scales. Preventability, severity was assessed
and total cost for management of the ADR was found to be ` 12,126. Thus, ADRs not only adds to
patient sufferings but also increase the economic burden. Health‑care providers need to be made
aware of potentially fatal ADRs associated with sulfa drugs and should be keen to report such ADRs
to drug safety authorities.