Trimethoprim-sulfamethoxazole-induced cholestatic hepatitis. Inadvertent rechallenge

Trimethoprim-sulfamethoxazole is known to produce hepatitis. We report a case involving the inadvertent rechallenge with trimethoprim-sulfamethoxazole (Bactrim) in a patient with a previous episode of drug-induced hepatitis. A liver biopsy specimen showed both cholestatic and cytotoxic changes consistent with drug-induced damage. Comparison with existing cases is presented and an immunologic cause is considered.