Fulminant hepatic failure in a child as a potential adverse effect of trimethoprim-sulphamethoxazole.
Trimethoprim-sulphamethoxazole (TMP-SMZ) is considered a safe drug for treatment of infectious bacterial diseases in children. Side-effects are rare and generally take the form of a hypersensitivity reaction to the sulphamethoxazole component of the drug. Hepatic injury usually presents as a transient elevation of liver enzymes, which is of little clinical relevance. Fulminant liver failure due to TMP-SMZ has been reported in only six adults and never in children. We here report a 5-year-old girl who developed fulminant liver failure 3 weeks after her third exposure to TMP-SMZ. After a biphasic clinical course she underwent successful liver transplantation.


CONCLUSIONS
Trimethoprim-Sulphamethoxazole may cause fulminant liver failure in children. The disease can run a biphasic clinical course and liver transplantation must be considered as the therapeutic option for these patients.
Simma
B
B
Department of Paediatrics, University of Innsbruck, Austria.
Meister
B
B
Deutsch
J
J
Sperl
W
W
Fend
F
F
Ofner
D
D
Margreiter
R
R
Vogel
W
W
D001706:Biopsy; D002675:Child, Preschool; D004927:Escherichia coli Infections / Q000188:drug therapy*; D005260:Female; D006501:Hepatic Encephalopathy / Q000139:chemically induced* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008099:Liver / Q000473:pathology; D008111:Liver Function Tests; D016031:Liver Transplantation; D012008:Recurrence; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage / Q000009:adverse effects*; D014552:Urinary Tract Infections / Q000188:drug therapy*
D015662:Trimethoprim, Sulfamethoxazole Drug Combination