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Related Experiment Video

Updated: May 15, 2026

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses

Published on: August 30, 2018

Trimethoprim/sulfamethoxazole induced multiorgan dysfunction.

Joshua Seung Oh Lee¹, David Owshalimpur, Christina Schofield

¹Department of Medicine, Madigan Army Hospital, Tacoma, Washington, USA. jjoshlee@gmail.com

BMJ Case Reports

|December 22, 2012

Summary

Trimethoprim/sulfamethoxazole can cause severe adverse events in AIDS patients, including hepatitis, pancreatitis, and kidney injury. Discontinuation of the drug and supportive care led to recovery.

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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses

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Human Liver Microphysiological System for Assessing Drug-Induced Liver Toxicity In Vitro

Human Liver Microphysiological System for Assessing Drug-Induced Liver Toxicity In Vitro

Published on: January 31, 2022

Area of Science:

Internal Medicine
Toxicology
Infectious Diseases

Background:

Pneumocystis jirovecii pneumonia (PCP) prophylaxis is crucial for individuals with Acquired Immunodeficiency Syndrome (AIDS).
Trimethoprim/sulfamethoxazole is a common prophylactic agent for PCP.

Observation:

A 22-year-old African-American man with AIDS developed altered mental state, malaise, and nausea shortly after initiating daily trimethoprim/sulfamethoxazole for PCP prophylaxis.
The patient presented with multiple organ system derangements, including hepatitis, pancreatitis, rhabdomyolysis, acute kidney injury, and hemolytic anemia.

Findings:

The adverse events were strongly associated with trimethoprim/sulfamethoxazole therapy.
Cessation of trimethoprim/sulfamethoxazole and supportive care, including volume expansion, resulted in complete resolution of symptoms and laboratory abnormalities.

Implications:

This case highlights the potential for severe, multi-organ toxicity associated with trimethoprim/sulfamethoxazole in immunocompromised patients.
Clinicians should maintain a high index of suspicion for drug-induced toxicity when patients with AIDS present with unexplained systemic illness while on trimethoprim/sulfamethoxazole.
Careful monitoring and prompt drug discontinuation are essential for managing such adverse events.