title: Fulminant liver failure and pancreatitis associated with the use of sulfamethoxazole-trimethoprim.
abstract: We report the case of a 26-yr-old patient with fulminant liver failure and acute hemorrhagic pancreatitis secondary to the use of trimethoprim-sulfamethoxazole (Bactrim DS). Our patient presented with skin rash and decreased C3 and C4 levels, which we believed was due to a hypersensitivity reaction secondary to the sulfonamide component (sulfamethoxazole). To our knowledge, this is the first case reported in which sulfamethoxazole-trimethoprim has been implicated as a cause of fulminant liver failure and acute hemorrhagic pancreatitis simultaneously, and emphasizes the need of discontinuing this medication as soon as there is evidence of liver and pancreatic dysfunction.
authors.affiliation: Department of Medicine, Mercy Hospital, Miami, Florida.
authors.forename: J J
authors.initials: JJ
authors.lastname: Alberti-Flor
authors.forename: M E
authors.initials: ME
authors.lastname: Hernandez
authors.forename: J P
authors.initials: JP
authors.lastname: Ferrer
authors.forename: S
authors.initials: S
authors.lastname: Howell
authors.forename: L
authors.initials: L
authors.lastname: Jeffers
mesh_terms: D000328:Adult; D056486:Chemical and Drug Induced Liver Injury; D003176:Complement C3 / Q000378:metabolism; D003181:Complement C4 / Q000378:metabolism; D004342:Drug Hypersensitivity / Q000150:complications / Q000378:metabolism; D004890:Erythema / Q000139:chemically induced; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D010195:Pancreatitis / Q000139:chemically induced*; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000009:adverse effects*
chemical_list: D003176:Complement C3; D003181:Complement C4; D015662:Trimethoprim, Sulfamethoxazole Drug Combination