title: Trimethoprim-sulfamethoxazole exacerbates posthypoxic action myoclonus in a patient with suspicion of Pneumocystis jiroveci infection.
abstract: We describe a 58-year-old patient with relapsing high-grade non-Hodgkin's lymphoma who exhibited exacerbation of posthypoxic action myoclonus during high-dose intravenous trimethoprim-sulfamethoxazole (TMP-SMX) treatment for highly suspicious Pneumocystis jiroveci pneumonia (PCP). Three months previously the patient had experienced a hypoxic insult caused by respiratory arrest due to an anaphylactic reaction to antibiotic therapy. He had developed posthypoxic action myoclonus (Lance-Adams syndrome), which was well controlled by oral treatment with piracetam. However, after TMP-SMX therapy (115 mg/kg daily) was started for suspicion of newly developed PCP, posthypoxic action myoclonus worsened dramatically resulting in complete disability. Anti-myoclonic therapy with increased doses of piracetam and valproic acid did not significantly improve his clinical condition. Only when TMPSMX doses were reduced (38 mg/kg daily) on day 12 did action myoclonus cease within 2 to 3 days. We suggest that TMP-SMX can exacerbate posthypoxic action myoclonus.
authors.affiliation: Dept. of Hematology and Oncology, Charité, Campus Virchow-Klinikum, Humboldt University of Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany. franziska.jundt@charite.de
authors.forename: F
authors.initials: F
authors.lastname: Jundt
authors.forename: T
authors.initials: T
authors.lastname: Lempert
authors.forename: B
authors.initials: B
authors.lastname: Dörken
authors.forename: A
authors.initials: A
authors.lastname: Pezzutto
mesh_terms: D000890:Anti-Infective Agents / Q000009:adverse effects*; D006801:Humans; D000860:Hypoxia / Q000150:complications; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D009207:Myoclonus / Q000139:chemically induced* / Q000209:etiology; D011010:Pneumocystis / Q000187:drug effects; D011020:Pneumonia, Pneumocystis / Q000188:drug therapy*; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000009:adverse effects*
chemical_list: D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination