title: Cholestatic hepatitis with severe systemic reactions induced by trimethoprim-sulfamethoxazole.
abstract: Trimethoprim-Sulfomethoxazole (TMP-SMX) related hepatotoxicity and associated severe systemic reaction are not frequent and documented only in case reports. We report a case of a 30-year-old man, who underwent a 15-day therapy with TMP-SMX for urinary tract infection and two weeks later developed acute cholestatic hepatitis, fever and a skin rash followed by severe systemic reaction. He was admitted in Intensive Care unit and with supportive therapy and prednisolone administration, he showed subsequent improvement over a period of few days. He had fully recovered months later. All tests for other causes of liver disease were negative and his liver biopsy showed evidence of drug-induced hepatic injury.
authors.affiliation: Gastroenterology and Hepatology Department, 424 Army Hospital, Thessaloniki, Greece.
authors.forename: G
authors.initials: G
authors.lastname: Kouklakis
authors.forename: A
authors.initials: A
authors.lastname: Mpoumponaris
authors.forename: P
authors.initials: P
authors.lastname: Zezos
authors.forename: J
authors.initials: J
authors.lastname: Moschos
authors.forename: A
authors.initials: A
authors.lastname: Koulaouzidis
authors.forename: A
authors.initials: A
authors.lastname: Nakos
authors.forename: A
authors.initials: A
authors.lastname: Pehlivanidis
authors.forename: M
authors.initials: M
authors.lastname: Iosiphidis
authors.forename: E
authors.initials: E
authors.lastname: Molyvas
authors.forename: N
authors.initials: N
authors.lastname: Nikolaidis
mesh_terms: D000328:Adult; D001706:Biopsy; D056486:Chemical and Drug Induced Liver Injury / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D002779:Cholestasis / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000473:pathology; D003937:Diagnosis, Differential; D004338:Drug Combinations; D006801:Humans; D008297:Male; D012720:Severity of Illness Index; D013419:Sulfamethizole / Q000009:adverse effects* / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D014295:Trimethoprim / Q000009:adverse effects* / Q000627:therapeutic use; D014552:Urinary Tract Infections / Q000188:drug therapy; D000096926:Benzenesulfonamides
chemical_list: D004338:Drug Combinations; D013419:Sulfamethizole; D014295:Trimethoprim; C029078:trimethoprim sulfamethizole; D000096926:Benzenesulfonamides