Patients taking Sulfasalazine should report any signs of which of the following?

• A. Nausea, vomiting, or diarrhea
• B. Skin rash only
• C. Joint pain only
• D. Unexplained bruising, bleeding, purpura, sore throat, fever or malaise

Answer: (D)

Sulfasalazine can cause serious suppression of the bone marrow, leading to low white blood cells (agranulocytosis/neutropenia) and low platelets (thrombocytopenia). Because of this, certain signs require urgent attention: unexplained bruising or bleeding and purpura point to low platelets, while sore throat, fever, or malaise can indicate an infection in someone with neutropenia. These are potentially life‑threatening and warrant prompt medical evaluation, possible test checks (blood counts), and may require stopping the medication.

Milder or more common effects like nausea, vomiting, or diarrhea, or even a skin rash, while important to monitor, do not on their own signal the same urgent risk of marrow suppression. Joint pain is typically related to the underlying condition or other drug effects, not a direct red-flag for this drug’s hematologic toxicity.