title: Severe septic-shock like reaction to co-trimoxazole in an HIV-positive man.
abstract: Adverse drug reactions occur at a greater frequency in HIV-infected individuals. A 38-year-old Eritrean man was treated with outpatient co-trimoxazole for confirmed Pneumocystis jirovecii pneumonia, but was switched to clindamycin and primaquine due to nausea and vomiting. Following development of methaemaglobinaemia, he was recommenced on prophylactic co-trimoxazole. He was later found moribund with features resembling septic shock and required invasive respiratory support. The diagnosis of a rare, but severe reaction to co-trimoxazole did not become apparent until he was rechallenged with prophylactic co-trimoxazole after recovery from his initial severe reaction. In an era of polypharmacy and an increasing availability of novel drugs, this case is a timely reminder to clinicians of the ongoing need for pharmacovigilance, especially in HIV-infected individuals who may have unusual presentations of an adverse drug reaction.
authors.affiliation: Department of HIV Medicine, Chelsea and Westminster Hospital, London, UK. andrew.scourfield@chelwest.nhs.uk
authors.forename: A
authors.initials: A
authors.lastname: Scourfield
authors.forename: L K K
authors.initials: LK
authors.lastname: Tan
authors.forename: M
authors.initials: M
authors.lastname: Nelson
mesh_terms: D000328:Adult; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000009:adverse effects*; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D045363:Pneumocystis carinii / Q000302:isolation & purification*; D011020:Pneumonia, Pneumocystis / Q000188:drug therapy* / Q000382:microbiology; D012772:Shock, Septic / Q000139:chemically induced*; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination