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Trimethoprim-sulphamethoxazole-associated rhabdomyolysis in an HIV-infected patient

S P Jen1, R Sharma

  • 1The University Hospital, Newark, NJ 07101-1709, USA. jensp@umdnj.edu

International Journal of STD & AIDS
|July 7, 2011
PubMed

Insights

Trimethoprim-sulfamethoxazole (TMP-SMZ) can cause rhabdomyolysis in HIV patients. Discontinuing TMP-SMZ led to recovery in a case of severe muscle pain and acute kidney injury.

Area of Science:

  • Infectious Diseases
  • Pharmacology
  • Nephrology

Background:

  • Human Immunodeficiency Virus (HIV) infection is associated with various opportunistic infections and drug toxicities.
  • Trimethoprim-sulfamethoxazole (TMP-SMZ) is a common antibiotic used for prophylaxis and treatment in HIV-infected individuals.
  • Drug-induced rhabdomyolysis is a rare but serious adverse effect of certain medications.

Observation:

  • A 33-year-old male with newly diagnosed Acquired Immunodeficiency Syndrome (AIDS) presented with high fevers attributed to TMP-SMZ.
  • Following hospital discharge, the patient was restarted on TMP-SMZ and subsequently developed severe myalgia, acute renal failure, and elevated creatine phosphokinase.
  • These clinical and laboratory findings were consistent with rhabdomyolysis.

Findings:

  • The case highlights a potential association between TMP-SMZ and the development of rhabdomyolysis in an HIV-infected patient.
  • Discontinuation of TMP-SMZ resulted in gradual clinical improvement and resolution of acute kidney injury.
  • This suggests TMP-SMZ may have contributed to the rhabdomyolysis in this specific patient context.

Implications:

  • Clinicians should consider TMP-SMZ as a potential cause of rhabdomyolysis in HIV-infected patients presenting with unexplained myopathy and renal dysfunction.
  • Awareness of this adverse effect is crucial for prompt diagnosis and management, potentially preventing severe complications.
  • Further investigation may be warranted to elucidate the mechanism of TMP-SMZ-induced rhabdomyolysis in immunocompromised individuals.

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