title: Successful extracorporeal liver dialysis for the treatment of trimethoprim-sulfamethoxazole-induced fulminant hepatic failure.
abstract: Trimethoprim-sulfamethoxazole (TMP-SMZ) is a commonly used antibiotic that has been associated with drug rash with eosinophilia and systemic symptoms (DRESS) syndrome. DRESS syndrome is characterised by fever, rash, lymphadenopathy, eosinophilia and one or more major organ involvement. Although rare, TMP-SMZ is a recognised cause of fulminant hepatic failure. We report a 17-year-old Chinese male adolescent who presented with fever, myalgia, generalised maculopapular rash and lymphadenopathy after taking TMP-SMZ for acne vulgaris. He subsequently developed hepatic encephalopathy and was worked up for urgent liver transplantation. He responded well to extracorporeal liver dialysis (originally intended as a bridging therapy) and subsequently recovered without the need for liver transplantation. This case report highlights the importance of early recognition of TMP-SMZ-induced DRESS syndrome and the need for early discontinuation of the drug in the affected patient. Extracorporeal liver dialysis and transplantation should be considered in the management of TMP-SMZ-induced fulminant hepatic failure.
authors.affiliation: Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore.
authors.forename: Choon Ta
authors.initials: CT
authors.lastname: Ng
authors.forename: Chee Kiat
authors.initials: CK
authors.lastname: Tan
authors.forename: Choon Chiat
authors.initials: CC
authors.lastname: Oh
authors.forename: Jason Pik Eu
authors.initials: JP
authors.lastname: Chang
mesh_terms: D000152:Acne Vulgaris / Q000150:complications / Q000188:drug therapy; D000293:Adolescent; D000890:Anti-Infective Agents / Q000009:adverse effects*; D001706:Biopsy; D003875:Drug Eruptions / Q000209:etiology; D063926:Drug Hypersensitivity Syndrome / Q000175:diagnosis / Q000209:etiology; D005334:Fever / Q000209:etiology; D006801:Humans; D017114:Liver Failure, Acute / Q000209:etiology* / Q000628:therapy*; D008206:Lymphatic Diseases / Q000209:etiology; D008297:Male; D063806:Myalgia / Q000209:etiology; D006435:Renal Dialysis / Q000379:methods*; D012867:Skin / Q000473:pathology; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000009:adverse effects*
chemical_list: D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination