Trimethoprim-sulfamethoxazole induced rash and fatal hematologic disorders.
Trimethoprim-sulfamethoxazole (TMP-SMX) is a combination chemotherapeutic agent, a commonly used antibiotic. Adverse drug reactions occur in 6-8% of patients. Although, the most common adverse reactions include mild gastrointestinal distress and cutaneous events, also a wide range of hematological abnormalities have been ascribed to TMP-SMX. We report a 40-year-old male patient who developed an early onset neutropenia, thrombocytopenia, generalised rash and oral candidiasis after 5 days long TMP-SMX therapy. Although generalised rash may seen more and improves with discontinuation of the therapy; severe neutropenia, thrombocytopenia and oral candidiasis are seen very rare and rarely leads to fatality as it was in our case. Despite thrombocyte transfusions, whole blood transfusions, red cell concentrates and filgrastim therapy we lost our patient. We want to underline that although the TMP-SMX combination is usually well tolerated it can also lead to fatal complications.
Infectious Diseases and Clinical Microbiology Department, Ministry of Health Ankara Research and Training Hospital, Ankara, Turkey. drzeliha@hotmail.com
Zeliha
Z
Kocak
Cigdem Ataman
CA
Hatipoglu
Gunay
G
Ertem
Sami
S
Kinikli
Abdurrahman
A
Tufan
Hasan
H
Irmak
Ali Pekcan
AP
Demiroz
D000328:Adult; D000890:Anti-Infective Agents / Q000009:adverse effects*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D002180:Candidiasis, Oral / Q000139:chemically induced / Q000188:drug therapy; D000077723:Cefepime; D002511:Cephalosporins / Q000008:administration & dosage; D002710:Chlorhexidine / Q000008:administration & dosage; D003875:Drug Eruptions / Q000209:etiology*; D004926:Escherichia coli / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000188:drug therapy; D005076:Exanthema / Q000139:chemically induced* / Q000188:drug therapy; D017809:Fatal Outcome; D000069585:Filgrastim; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage; D006801:Humans; D008297:Male; D000077731:Meropenem; D009503:Neutropenia / Q000139:chemically induced* / Q000628:therapy; D009761:Nystatin / Q000008:administration & dosage; D017713:Platelet Transfusion; D011239:Prednisolone / Q000008:administration & dosage; D011994:Recombinant Proteins; D013845:Thienamycins / Q000008:administration & dosage; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000628:therapy; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000009:adverse effects*
D000890:Anti-Infective Agents; D000893:Anti-Inflammatory Agents; D002511:Cephalosporins; D011994:Recombinant Proteins; D013845:Thienamycins; D009761:Nystatin; D016179:Granulocyte Colony-Stimulating Factor; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D000077723:Cefepime; D011239:Prednisolone; D000077731:Meropenem; D000069585:Filgrastim; D002710:Chlorhexidine