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A 21-year-old woman with Crohn's disease of the colon developed a skin rash after 3 weeks of treatment with sulfasalazine. Administration of sulfasalazine was discontinued. When mesalazine was instituted 1 week later, she developed a severe hypersensitivity reaction characterized by fever, diarrhea, skin rash with subsequent desquamation, marked atypical lymphocytosis, and severe hepatotoxicity. Recovery was complete. The clinical and biological features as well as liver pathology of this case bear a striking resemblance to earlier reports of hypersensitivity reaction with severe hepatotoxicity to sulfasalazine. The authors urge caution when mesalazine is given to a patient with known hypersensitivity to sulfasalazine.

Belgian Assoc Study Liver, Ghent, Belgium. Univ Hosp Gent, Ghent, Belgium. Ctr Biostat, Diepenbeek, Belgium.

Six patients with known achalasia were examined by endoscopic ultrasonography before dilatation therapy. At the level of the lower esophageal sphincter, a typical enlargement of the echolayer corresponding to the muscularis propria was observed in 5 cases. Endoscopic ultrasonography is a complementary procedure to manometry and x-ray for diagnosing achalasia. It helps differentiate achalasia from pseudoachalasia. In pseudoachalasia there is tumor infiltration.