Drug-induced pneumonitis caused by sulfamethoxazole, trimethoprim during treatment of Pneumocystis carinii pneumonia in a patient with refractory ulcerative colitis.
We recently treated a patient with intractable ulcerative colitis complicated with Pneumocystis carinii pneumonia in whom sulfamethoxazole/trimethoprim caused pneumonitis. The pneumonitis was difficult to differentiate from worsening of the infection or the appearance of another opportunistic infection. The patient's history of sulfasalazine (sulfonamide)-induced pneumonitis made diagnosis possible. The CD4/CD8 ratio of lymphocyte subsets in bronchoalveolar lavage fluid was decreased at the diagnosis of Pneumocystis carinii pneumonia and this ratio had increased when drug-induced pneumonitis was diagnosed. Topical administration of beclomethasone dipropionate by enema was a safe and effective for the treatment of such a compromised patient with active colitis.
Third Department of Internal Medicine, Osaka City University Medical School, Osaka, Japan.
N
N
Oshitani
T
T
Matsumoto
Y
Y
Moriyama
S
S
Kudoh
K
K
Hirata
T
T
Kuroki
D000328:Adult; D000890:Anti-Infective Agents / Q000009:adverse effects*; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology / Q000276:immunology; D003093:Colitis, Ulcerative / Q000150:complications*; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D011014:Pneumonia / Q000139:chemically induced* / Q000175:diagnosis* / Q000473:pathology; D011020:Pneumonia, Pneumocystis / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D013420:Sulfamethoxazole / Q000009:adverse effects*; D014295:Trimethoprim / Q000009:adverse effects*
D000890:Anti-Infective Agents; D014295:Trimethoprim; D013420:Sulfamethoxazole