trimethoprim--sulfamethoxazole-drug-combination and Alcoholism

A 50-year-old woman was admitted to our emergency room because of progressive weakness. She collapsed the night before admission. Skin and mucosa were pale, she denied major infections or bleedings. An alcohol abuse was known for many years. Because of edema she received a therapy with triamteren, an infection of the urinary tract was treated with cotrimoxacol.. In addition to thrombocytopenia (50 Gpt/l) and leukocytopenia (1,51 10 (9)/l) we diagnosed a hyperchromic and macrocytic anemia (Hb 3,6 mmol/l [5,8 g/dl], Hk 0,17, MCH 2.52 fmol, 116,8 fl). Folic acid was decreased to 0.677 ng/ml, whereas levels of cobalamin, ferritin and iron were normal. Examination of bone marrow showed a hypercellular marrow with typical megaloblastic features of erythropoiesis and granulopoiesis. A systemic hematological disorder could be ruled out. The folic acid deficiency in our patient was the result of a long time alcohol abuse and a simultaneous therapy with mild folate antagonists (triamteren and cotrimoxacol).. The patient received folic acid (5 mg/d orally). Within one week the peripheral blood counts increased to normal, the follow up bone marrow examination showed a hyperplastic marrow with normal hematopoietic maturation.. Folic acid deficiency can be aggravated because of simultaneous therapy with mild folate antagonists. In addition to megaloblastic anemia this can lead to thrombocytopenia and/or leukocytopenia. Therefore in patients with pancytopenia a deficiency of folic acid should be ruled out.

Topics: Alcoholism; Anemia, Macrocytic; Anti-Infective Agents, Urinary; Diagnosis, Differential; Diuretics; Edema; Female; Folic Acid; Folic Acid Antagonists; Folic Acid Deficiency; Humans; Middle Aged; Pancytopenia; Triamterene; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Chronic bronchitis is characterized by chronic, productive cough present on most days for at least three months of the year. Differential diagnosis must exclude an endobronchial obstructive lesion, asthma, nocturnal aspiration, bronchiectasis, cystic fibrosis, and immotile cilia syndrome. The most characteristic finding in patients with chronic bronchitis is hypertrophy of the mucous glands and goblet cells.

Topics: Alcoholism; Amoxicillin; Ampicillin; Animals; Bronchitis; Bronchodilator Agents; Chronic Disease; Diagnosis, Differential; Dogs; Drug Combinations; Humans; Ipratropium; Klebsiella Infections; Metaproterenol; Respiratory Tract Infections; Sulfamethoxazole; Tetracycline; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination