Acute fulminant hepatic failure in a woman treated with phenytoin and trimethoprim-sulfamethoxazole.
Massive hepatic necrosis following exposure to phenytoin and trimethoprim-sulfamethoxazole is a rare occurrence and to the best of our knowledge has not been reported previously. Acute hepatic failure following administration of trimethoprim-sulfamethoxazole has rarely been seen, and only 4 cases have been well documented pathologically. We report a case of acute liver failure in a 60-year-old woman following ingestion of phenytoin and trimethoprim-sulfamethoxazole concomitantly over a 9-day period. Autopsy findings revealed acute fulminant hepatic failure. This case demonstrates the effects of chemical-chemical interactions in the potentiation of hepatotoxicity of single agents and specifically illustrates the need for discontinuing trimethoprim-sulfamethoxazole in the presence of early liver injury.
Ilario
M J
MJ
Department of Pathology, State University of New York Health Science Center at Brooklyn, 11203, USA.
Ruiz
J E
JE
Axiotis
C A
CA
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002675:Child, Preschool; D004347:Drug Interactions; D017809:Fatal Outcome; D005260:Female; D006501:Hepatic Encephalopathy / Q000139:chemically induced* / Q000473:pathology; D006801:Humans; D008099:Liver / Q000187:drug effects / Q000473:pathology; D008875:Middle Aged; D009336:Necrosis; D010672:Phenytoin / Q000009:adverse effects*; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000009:adverse effects*
D010672:Phenytoin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination