Related Experiment Video
Updated: Jul 3, 2026
Inducing Acute Liver Injury in Rats via Carbon Tetrachloride (CCl4) Exposure Through an Orogastric Tube
Published on: April 28, 2020
Acute Liver Injury Following Outpatient Trimethoprim-Sulfamethoxazole Use for Small Intestinal Bacterial Overgrowth:
Kaylie Duit1, Joseph Rattenni1, Lauryn Hanson1
1University of Iowa Iowa City Iowa USA.
Abstract:
Drug-induced liver injury (DILI) is a leading cause of acute liver failure in the United States and remains difficult to predict and diagnose. Trimethoprim-sulfamethoxazole (TMP-SMX) is widely prescribed and generally well tolerated, yet rare cases of severe idiosyncratic hepatotoxicity have been reported. We describe a 30-year-old woman who developed fever, malaise, leukopenia, and profound hepatocellular injury days after initiating TMP-SMX and neomycin for small intestinal bacterial overgrowth. TMP-SMX was discontinued, and treatment with N-acetylcysteine (NAC) and supportive care was initiated. Liver enzymes, coagulopathy, and renal dysfunction steadily improved, and the patient was discharged on hospital day 6 with complete resolution of laboratory abnormalities within one month. In addition to highlighting another documented case of liver injury caused by TMP-SMX, this case emphasizes the unpredictable nature of drug-induced hepatotoxicity, the potential use of NAC in DILI, and reinforces the importance of early recognition, comprehensive evaluation, and prompt withdrawal of the offending agent. Clinicians should maintain vigilance when new constitutional or hepatic symptoms arise during therapy and should report suspected cases to improve collective understanding and patient safety data.
Insights
Drug-induced liver injury (DILI) from Trimethoprim-sulfamethoxazole (TMP-SMX) is rare but serious. Early recognition and prompt withdrawal of the offending agent are crucial for patient recovery and improved outcomes.
Area of Science:
- Hepatology
- Clinical Pharmacology
- Internal Medicine
Background:
- Drug-induced liver injury (DILI) is a significant cause of acute liver failure.
- Trimethoprim-sulfamethoxazole (TMP-SMX) is a commonly prescribed antibiotic with rare reports of severe hepatotoxicity.
- Predicting and diagnosing DILI remains a clinical challenge.
Purpose of the Study:
- To report a case of severe idiosyncratic hepatotoxicity associated with TMP-SMX.
- To highlight the potential role of N-acetylcysteine (NAC) in managing DILI.
- To emphasize the importance of early DILI recognition and management.
Main Methods:
- Case report of a 30-year-old female patient.
- Detailed clinical presentation, laboratory findings, and treatment course.
- Review of literature on TMP-SMX-induced liver injury and NAC use in DILI.
Main Results:
- The patient developed fever, malaise, leukopenia, and hepatocellular injury after TMP-SMX initiation.
- Discontinuation of TMP-SMX and administration of NAC led to significant improvement in liver enzymes, coagulopathy, and renal function.
- Complete laboratory resolution was achieved within one month post-discharge.
Conclusions:
- TMP-SMX can cause rare but severe idiosyncratic hepatotoxicity.
- N-acetylcysteine (NAC) may be a beneficial adjunct in DILI management.
- Vigilance, early diagnosis, and prompt drug withdrawal are essential for managing DILI.
Related Concept Videos
01:27Inflammatory Bowel Disease I: Ulcerative Colitis
Inflammatory bowel disease, or IBD, encompasses a group of disorders characterized by chronic inflammation or ulceration of the gastrointestinal tract.
Risk Factors
The exact cause of IBD remains unclear, although it is believed to be due to a mix of genetic, environmental, microbial, and immune factors. Genetic factors are significant in determining susceptibility to IBD, with family history being a critical risk factor. Individuals with a first-degree relative who has IBD are at...
01:17Chronic Bowel Disorders: Introduction
Irritable Bowel Syndrome (IBS) is a common disorder affecting the gastrointestinal tract. The distinctive feature is recurrent abdominal pain associated with altered bowel movements, manifesting as constipation, diarrhea, or fluctuating between both. The...