Trimethoprim-sulfamethoxazole-induced cholestatic hepatitis. Inadvertent rechallenge

Area of Science:

• Hepatology
• Pharmacology
• Immunology

Background:

• Trimethoprim-sulfamethoxazole is a widely used antibiotic combination.
• Drug-induced liver injury (DILI) is a significant concern with many medications.
• Previous episodes of DILI necessitate careful consideration of re-exposure.

Observation:

• A patient with a history of drug-induced hepatitis was inadvertently re-exposed to trimethoprim-sulfamethoxazole.
• The patient presented with symptoms indicative of liver injury following re-administration.
• Liver biopsy revealed cholestatic and cytotoxic changes.

Findings:

• The liver biopsy findings were consistent with drug-induced liver damage.
• Rechallenge with trimethoprim-sulfamethoxazole led to recurrent hepatitis.
• The observed liver damage exhibited both cholestatic and cytotoxic features.

Implications:

• This case underscores the potential hepatotoxicity of trimethoprim-sulfamethoxazole.
• Inadvertent rechallenge can precipitate severe drug-induced liver injury.
• An immunologic mechanism is considered a potential cause for this adverse reaction.