Trimethoprim-sulfamethoxazole-induced Steven Johnson syndrome in an HIV-infected patient

Area of Science:

• Pharmacology
• Immunology
• Dermatology

Background:

• Trimethoprim-sulfamethoxazole (TMP/SMX) is a common antibiotic for various infections.
• It is frequently used for Pneumocystis jirovecii pneumonia (PCP) prophylaxis in HIV-infected individuals.
• HIV-infected patients exhibit a higher incidence and severity of adverse reactions to TMP/SMX.

Observation:

• A case report details a patient experiencing Stevens-Johnson syndrome (SJS) after TMP/SMX treatment.
• The patient presented with a widespread mucocutaneous reaction affecting the eyes, oral cavity, and genitals.
• Laboratory findings included elevated liver enzymes (alanine aminotransferase and aspartate aminotransferase).

Findings:

• Discontinuation of TMP/SMX therapy was followed by supportive care.
• The patient's condition showed improvement eight days after cessation of the antibiotic.
• This case highlights a severe adverse drug reaction to TMP/SMX in an HIV-positive individual.

Implications:

• Clinicians should maintain a high index of suspicion for severe cutaneous adverse reactions (SCARs) like SJS with TMP/SMX use, especially in HIV patients.
• Early recognition and withdrawal of the offending agent are crucial for managing TMP/SMX-induced SJS.
• This case underscores the importance of careful monitoring and risk-benefit assessment when prescribing TMP/SMX to immunocompromised populations.