title: Hypoglycaemia associated with co-trimoxazole use in a 56-year-old Caucasian woman with renal impairment.
abstract: Here we present a case of refractory hypoglycaemia associated with use of the antibiotic trimethoprim-sulfamethoxazole (TMP-SMX). This was used to treat Pneumocystis jirovecii pneumonia (PCP) infection. The patient had significant pre-existing renal impairment with a kidney transplant in situ. Refractory hypoglycaemia occurred 5 days after starting the antibiotic and persisted for 36 h after its cessation. SMX contains the same sulphanilamide structural group as the oral hypoglycaemic agents called sulphonureas. SMX could therefore act as an insulin secretagogue. The inappropriately raised insulin and c-peptide levels seen in our patient support this theory. The 5-day asymptomatic period would allow sufficient time for the drug to accumulate and the extended period seen after its cessation would be seen in a dose-dependent side effect. Following 3 days of observation and continuous glycaemic support on the High Dependency Unit she was discharged back to the ward, with no further occurrence of hypoglycaemia.
authors.affiliation: Department of Infection and Tropical Medicine, Sheffield Teaching Hospital, Sheffield, UK. donallforde@gmail.com
authors.forename: Donall G
authors.initials: DG
authors.lastname: Forde
authors.forename: Jody
authors.initials: J
authors.lastname: Aberdein
authors.forename: Anne
authors.initials: A
authors.lastname: Tunbridge
authors.forename: Ben
authors.initials: B
authors.lastname: Stone
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002096:C-Peptide / Q000378:metabolism; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000209:etiology*; D007328:Insulin / Q000097:blood; D016030:Kidney Transplantation; D008875:Middle Aged; D011020:Pneumonia, Pneumocystis / Q000188:drug therapy; D051437:Renal Insufficiency / Q000150:complications*; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000009:adverse effects* / Q000627:therapeutic use; D044465:White People
chemical_list: D000900:Anti-Bacterial Agents; D002096:C-Peptide; D007328:Insulin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination