title: Reversible myoclonus, asterixis, and tremor associated with high dose trimethoprim-sulfamethoxazole: a case report.
abstract: METHODS
  Reversible myoclonus, tremor, and asterixis induced by high dose trimethoprim-sulfamethoxazole.
  
  
  METHODS
  The patient was a 66-year-old male with T9 AIS(1) C quadriplegia secondary to spinal cord compression by a tumor due to large B cell lymphoma. Subsequent to tumor resection and chemotherapy, the patient was discovered to have Pneumocystis jiroveci pneumonia (PJP). Once started on high dose trimethoprim-sulfamethoxazole (TMP-SMX) therapy (15.6 mg/kg/day of trimethoprim) for the treatment of PJP, he displayed bilateral upper extremity myoclonic jerks at rest, asterixis, and postural tremor. Symptoms resolved once TMP-SMX therapy was discontinued.
  
  
  CONCLUSIONS
  Myoclonus, asterixis, and tremor have been linked to high dose TMP-SMX therapy as a toxic side effect. Our patient's symptoms did improve with levetiracetam therapy, but did not fully resolve until TMP-SMX was discontinued.
  
  
  CONCLUSIONS
  This is thought to be the first reported case of reversible myoclonus, tremor, and asterixis induced by high dose TMP-SMX in the spinal cord injury population. Early recognition of TMP-SMX induced complications were of key importance as they negatively impacted the rehabilitation process. We also recommend consideration of symptomatic treatment with levetiracetam for the duration of required TMP-SMX therapy as it appeared to mitigate the severity of our patient's movement disorders.
authors.forename: Damon A
authors.initials: DA
authors.lastname: Gray
authors.forename: Dominic
authors.initials: D
authors.lastname: Foo
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D004409:Dyskinesia, Drug-Induced / Q000209:etiology*; D006801:Humans; D008297:Male; D011020:Pneumonia, Pneumocystis / Q000150:complications / Q000188:drug therapy*; D013119:Spinal Cord Injuries / Q000150:complications*; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
keywords: Dyskinesias; Etiracetam; Myoclonus; Physical and rehabilitation medicine; Pneumocystis; Pneumocystis jirovecii; Pneumonia; Spinal cord injuries; Tremor; Trimethoprim-sulfamethoxazole combination