Hepatotoxicity induced by trimethoprim-sulfamethoxazole in a child with cystic fibrosis.
Patients with cystic fibrosis (CF) have chronic and progressive lung infections with various bacterial organisms that require treatment with oral and intravenous antibiotics on a regular basis. Trimethoprim-sulfamethoxazole (TMP-SMX) is one of the medications used to treat acute pulmonary infectious exacerbations in patients with CF. Hepatic toxicity secondary to TMP-SMX was previously described in normal subjects but has not been reported in children with CF. Here we describe a 14-year-old female child with CF who was given oral TMP-SMX for an acute pulmonary infectious exacerbation. She developed a rash, severe constitutional symptoms, and significant elevation of liver enzyme concentrations secondary to immunity-mediated reaction to TMP-SMX. Discontinuation of TMP-SMX and supportive treatment led to resolution of her symptoms and normalization of liver enzyme concentrations.
Pediatric Pulmonary Division, The Carman and Ann Adams Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, Michigan.
Ibrahim
I
Abdulhamid
Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan.
Victoria Tutag
VT
Lehr
cystic fibrosis; hepatotoxicity; liver enzymes; trimethoprim-sulfamethoxazole