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Cholestatic hepatitis with severe systemic reactions induced by trimethoprim-sulfamethoxazole

G Kouklakis1, A Mpoumponaris, P Zezos

  • 1Gastroenterology and Hepatology Department, 424 Army Hospital, Thessaloniki, Greece.

Annals of Hepatology
|February 14, 2007
PubMed

Insights

Trimethoprim-Sulfamethoxazole (TMP-SMX) can cause rare but severe liver injury and systemic reactions. Prompt supportive care and corticosteroids aided recovery in a patient with drug-induced cholestatic hepatitis.

Area of Science:

  • Hepatology
  • Pharmacology
  • Toxicology

Background:

  • Trimethoprim-Sulfamethoxazole (TMP-SMX) is a common antibiotic.
  • Hepatotoxicity and severe systemic reactions are infrequent but serious adverse effects.

Observation:

  • A 30-year-old man developed acute cholestatic hepatitis, fever, and rash two weeks after a 15-day TMP-SMX course for a urinary tract infection.
  • Symptoms progressed to a severe systemic reaction, necessitating intensive care unit admission.

Findings:

  • The patient improved with supportive therapy and prednisolone.
  • Liver biopsy confirmed drug-induced hepatic injury, with other causes ruled out.

Implications:

  • This case highlights the potential for severe hepatotoxicity from TMP-SMX.
  • Early recognition and management are crucial for favorable outcomes in drug-induced liver injury.

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