Severe and long lasting cholestasis after high-dose co-trimoxazole treatment for Pneumocystis pneumonia in HIV-infected patients--a report of two cases.
Pneumocystis pneumonia (PCP), a common opportunistic infection in HIV-infected individuals, is generally treated with high doses of co-trimoxazole. However, treatment is often limited by adverse effects. Here, we report two cases of severely immunocompromised HIV-infected patients who developed severe intrahepatic cholestasis, and in one patient lesions mimicking liver abscess formation on radiologic exams, during co-trimoxazole treatment for PCP. Whereas patient 1 showed lesions of up to 1 cm readily detectable on magnetic resonance imaging under prolonged co-trimoxazole treatment, therapy of patient 2 was switched early.
Hanses
F
F
Department of Internal Medicine I, University Hospital, University of Regensburg, 93042 Regensburg, Germany. frank.hanses@klinik.uni-r.de
Zierhut
S
S
Schölmerich
J
J
Salzberger
B
B
Wrede
C E
CE
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000382:microbiology; D000328:Adult; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D002780:Cholestasis, Intrahepatic / Q000139:chemically induced* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D016867:Immunocompromised Host; D008279:Magnetic Resonance Imaging; D008297:Male; D045363:Pneumocystis carinii / Q000187:drug effects; D011020:Pneumonia, Pneumocystis / Q000188:drug therapy* / Q000382:microbiology; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D055815:Young Adult
D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination