Could Sigmoid Diverticulitis, Drug-Induced Liver Injury, and Drug-Induced Pancreatitis Co-occur?

Sigmoid diverticulitis is a leading cause of gastrointestinal pathology etiology, which causes hospital admissions in Western society. Recent studies have shown its prevalence to be 1-4%. Drug-induced liver injury (DILI) is a primary cause of acute liver failure in the West. The incidence of DILI is between 14-19 cases per 100,000 population. The prevalence of drug-induced pancreatitis (DIP) is 2-5%, although this is hard to estimate given the lack of large-scale studies. Sulfasalazine is a disease-modifying antirheumatic drug that is indicated for the treatment of chronic inflammatory diseases such as rheumatoid arthritis and ulcerative colitis. It has been associated with severe adverse reactions such as pancreatitis or liver injury. We present a patient with a triad of DILI, DIP, and sigmoid diverticulitis in the setting of the recent initiation of sulfasalazine. Such a clinical scenario has not been previously reported in medical literature.