Trimethoprim-sulfamethoxazole induced aseptic meningitis in a renal transplant patient.
A 45-year-old man underwent renal transplant for end-stage renal disease complicating systemic lupus erythematosis. Within 24 hours of initiating Pneumocystis carinii pneumonia (PCP) prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMX) he developed fever and confusion. Cerebrospinal fluid examination revealed a pleocytosis but cultures were negative. The patient improved within three days after cessation of the TMP-SMX but symptoms recurred rapidly upon drug rechallenge. Drug-induced aseptic meningitis is an uncommon but well described clinical entity. This is the first case described in a patient following renal transplantation. The literature is reviewed and the clinical features, diagnostic challenges and possible mechanisms of TMP-SMX-induced aseptic meningitis are discussed. This problem may be more common in the transplant population than is recognized given the difficulty of diagnosis combined with the widespread use of TMP-SMX as PCP prophylaxis.
Muller
M P
MP
Department of Medicine, The Toronto General Hospital, University Health Network, Ontario, Canada.
Richardson
D C
DC
Walmsley
S L
SL
D000890:Anti-Infective Agents / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008582:Meningitis, Aseptic / Q000139:chemically induced* / Q000175:diagnosis; D008875:Middle Aged; D011020:Pneumonia, Pneumocystis / Q000517:prevention & control; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000009:adverse effects* / Q000627:therapeutic use
D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination