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Sulfasalazine and folate deficiency.

To the Editor.— The findings that sulfasalazine inhibits folate transport,1inhibits the hydrolysis of polyglutamyl folate, and decreases the absorption of both polyglutamyl and monoglutamyl folates suggest, as recently reported by Halstead et al,2that folate deficiency may be prevented by increasing folate intake while the patient receives sulfasalazine. We would like to describe a patient with ulcerative colitis while receiving sulfasalazine in whom severe anemia secondary to folate deficiency and aggravated by an immunohemolytic process was identified and later treated with the use of folic acid. Report of a Case.— A 39-year-old woman was initially seen at an emergency room because of weakness, dyspnea, and fatigue of three weeks' duration. She had a ten-year history of verified ulcerative colitis treated with sulfasalazine, 4 g/day. Her disease had been quiescent; she denied experiencing fever, nausea, vomiting, abdominal pain, diarrhea, hematochezia, or weight loss. The patient did not smoke,