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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
PubMed

Insights

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.

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.

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