trimethoprim--sulfamethoxazole-drug-combination and Anemia--Hemolytic--Autoimmune

Although disseminated nocardiosis has been increasing with the expansion of immunosuppressive therapy and improvement in diagnostic methods, muscle abscess is a rare complication. There have been only nine case reports of muscle abscess due to Nocardia infection in the English-language published work. We present a case of muscle abscess with disseminated nocardiosis, and review the published work. The patient had been taking prednisolone at 20 mg a day for autoimmune hemolytic anemia for 14 years. She presented with erythema on her thigh resembling cellulitis. Computed tomography showed muscle abscess. The isolated organism was identified as Nocardia farcinica employing polymerase chain reaction and antibiotic sensitivity testing. The diagnosis of muscle abscess due to nocardiosis can be easily missed because there are no characteristic symptoms.

Topics: Abscess; Anemia, Hemolytic, Autoimmune; Anti-Bacterial Agents; Brain Abscess; Female; Humans; Immunosuppressive Agents; Middle Aged; Muscular Diseases; Nocardia; Nocardia Infections; Prednisolone; Trimethoprim, Sulfamethoxazole Drug Combination

A case report of drug-induced immune hemolytic anemia (DIIHA) triggered by exposure to trimethoprim-sulfamethoxazole is presented along with a brief review of the pathophysiology of DIIHA and diagnostic considerations.. A 58-year-old woman developed warm autoimmune hemolytic anemia after receiving trimethoprim-sulfamethoxazole for 5 days.

Topics: Anemia, Hemolytic, Autoimmune; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Female; Humans; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination

Drug-induced immune haemolytic anaemia is a rare but serious condition. This study investigated the possibility of drug aetiology of immune haemolytic anaemia (IHA) in 134 patients with new onset of IHA who were identified in the Berlin Case-Control Surveillance Study between 2000 and 2009. Single drugs related to IHA in three or more patients and assessed more than once as a certain or probable cause of IHA in a standardized causality assessment included diclofenac, fludarabine, oxaliplatin, ceftriaxone and piperacillin. In a case-control study including all 124 IHA cases developed in outpatient care and 731 controls, significantly increased odds ratios (OR) were observed for beta-lactam antibiotics (OR=8·8; 95% confidence interval [CI] 3·2-25·2), cotrimoxazole (OR=6·5; CI 1·1-37·9), ciprofloxacin (OR=6·9, CI 1·3-38·5), fludarabine (OR=22·2; CI: 2·8-454·5) and lorazepam (OR=5·3; CI: 1·2-21·2). Excluding new onset cases with a chronic IHA disease course, an increased risk became also apparent for diclofenac with an OR of 3·1 (CI 1·3-7·0). This is the first case-control study investigating drugs as risk factors for IHA. It corroborates an increased risk for several drugs that have been implicated as a cause of IHA in the standardized causality assessment of individual cases.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anemia, Hemolytic, Autoimmune; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Antineoplastic Agents; Berlin; beta-Lactams; Case-Control Studies; Ciprofloxacin; Diclofenac; Drug-Related Side Effects and Adverse Reactions; Female; Humans; Lorazepam; Male; Middle Aged; Odds Ratio; Piperacillin; Population Surveillance; Trimethoprim, Sulfamethoxazole Drug Combination; Vidarabine; Young Adult

Immune-mediated hemolytic anemia (IMHA) occurs in cattle; however, there are few reported cases.. The aim of this study was to investigate the prevalence of IMHA in cattle with anemia, describe the associated clinical and laboratory findings, including osmotic fragility, and identify potential causative infectious agents or drugs.. This study included 42 anemic cattle (HCT < 27.5%) comprising 31 females and 11 bulls with a mean age of 3.5 years referred to the University of Tehran Veterinary Teaching Hospital during a 10-month period. CBCs, saline osmotic fragility tests, direct Coombs' tests, and biochemical profiles were performed, and blood smears were evaluated for spherocytosis, parasites, and microscopic agglutination. Five clinically healthy cattle were used as controls for testing osmotic fragility of RBCs.. The Coombs' test was positive in 13/42 (30%) cattle; 5 had no evidence of concurrent disease or history of drug administration, and 8 had underlying or concurrent diseases, positivity for BLV, or exposure to drugs. The HCT (mean ± SE) of Coombs'-positive cattle (16 ± 1.7%) was significantly lower than that of Coombs'-negative animals (21 ± 0.8%). Hematologic and biochemical findings in cattle with IMHA included anisocytosis (2), polychromasia (2), basophilic stippling (2), spherocytosis (2), hyperfibrinogenemia (5), left-shifted neutrophilia (3), and hyperbilirubinemia (8). RBCs from Coombs'-positive anemic cattle were more fragile than those from Coombs'-negative anemic cattle. Four osmotically different populations of RBCs were detected in cattle with IMHA, whereas RBC populations were homogeneous in the Coombs'-negative anemic cattle and in normal cattle.. IMHA was identified in a significant proportion of anemic cattle. Idiopathic IMHA and IMHA secondary to infectious diseases and administration of certain drugs occur in cattle.

Topics: Anemia, Hemolytic, Autoimmune; Animals; Cattle; Cattle Diseases; Coombs Test; Female; Fibrinogen; Male; Osmotic Fragility; Trimethoprim, Sulfamethoxazole Drug Combination

Nocardial infections in an immunocompromised host have been increasingly reported. Nocardial brain abscess, the most common presentation of nocardiosis in the central nervous system, is associated with a high mortality rate because of its delayed diagnosis and its unresponsiveness to the usual antibiotic therapy. We report four patients who experienced a long-term cure of nocardial brain abscess due to treatment by a combination of surgery and postoperative antibiotic therapy; 1 man and 3 women, ages ranging from 43 to 67 years old. Two patients were associated with systemic lupus erythematosus and two with autoimmune hemolytic anemia. Patients underwent surgical aspiration and drainage of brain abscess. Nocardia was identified from the aspirated specimen and postoperative antibiotic therapy for 5-6 weeks was performed using effective antibiotic agents; sulfamethoxazole/trimethoprim (ST), imipenem/cilastatin and minocycline (MINO) in Case 1, ST and MINO in Case 2, erythromycin in Case 3, and panipenem/betamipron and cefotaxime in Case 4. Case 3 and Case 4 with multilobulated brain abscess underwent total excision of the brain abscess. All patients showed successful cure of nocardial brain abscess with no recurrence for the period of 1-8 years. The combination of surgery and postoperative antibiotic therapy provides a good prognosis for nocardial brain abscess.

Topics: Adult; Aged; Anemia, Hemolytic, Autoimmune; Anti-Bacterial Agents; beta-Alanine; Brain Abscess; Cefotaxime; Cilastatin; Cilastatin, Imipenem Drug Combination; Drainage; Drug Combinations; Drug Therapy, Combination; Female; Humans; Imipenem; Immunocompromised Host; Lupus Erythematosus, Systemic; Male; Middle Aged; Minocycline; Nocardia Infections; Postoperative Care; Thienamycins; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abdominal Pain; Anemia, Hemolytic, Autoimmune; Child; Female; Humans; Prednisolone; Respiratory Tract Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Two women were seen for evaluation of acrocyanosis and vasculitis limited to the toes. General studies showed only the presence of low titer cold hemagglutinins. Complete rapid clearing of the cutaneous changes was achieved after treatment with systemic cephradine in one case and penicillin in the other. This supports the view that cold agglutinins, arising as a result of occult bacterial infection, were responsible for the clinical presentation of blue toes.

Topics: Adult; Aged; Anemia, Hemolytic, Autoimmune; Bacterial Infections; Cephalosporins; Cephradine; Cyanosis; Drug Combinations; Female; Humans; Penicillin V; Sulfamethoxazole; Toes; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination