trimethoprim--sulfamethoxazole-drug-combination and Antiphospholipid-Syndrome

We report the case of a 35-year-old male, who was diagnosed with systemic lupus erythematosus (SLE) in 2010 based on the presence of articular, serous, renal, immune, and hematologic involvement. He also had secondary antiphospholipid syndrome (APS). He was treated with prednisone 10 mg per day, hydroxychloroquine 200 mg per day, methotrexate 12.5 mg per week, leflunomide 20 mg per day, and oral anticoagulation previous to the present event. He presented to emergency room with a 7 day disease duration characterized by pain in the left thigh, which increased with physical activity, resulting in claudication; he also had malaise and fever. The X-ray films showed periostitis of the lower half of the left femur with bone marrow narrowing; the scintigraphy showed marked increased uptake in the middle and distal thirds of the left femur, and magnetic resonance imaging (MRI) showed thickening and hyperintensity of the cortex of the diaphysis and distal epiphysis of the femur and endosteal irregularity. Empirical treatment was started with vancomycin for 3 weeks. Femur biopsy and cultures were performed, isolating Salmonella spp. group "D" Vi (-); treatment with cotrimoxazole and ceftazidime for 4 weeks followed by doxycycline and cotrimoxazole for 4 months were given with a favorable functional outcome. This is an unusual case of a young adult with Garre's sclerosing osteomyelitis associated to SLE and caused by salmonella. The literature is reviewed and the clinical conditions predisposing to this infection are discussed, particularly in patients with SLE.

Topics: Adult; Anti-Bacterial Agents; Antiphospholipid Syndrome; Ceftazidime; Doxycycline; Femur; Humans; Hydroxychloroquine; Immunosuppressive Agents; Isoxazoles; Leflunomide; Lupus Erythematosus, Systemic; Male; Methotrexate; Osteomyelitis; Prednisone; Salmonella Infections; Sclerosis; Trimethoprim, Sulfamethoxazole Drug Combination

Antiphospholipid antibody syndrome (APS) results from autoantibodies to cell surface phospholipids or phospholipid-binding proteins resulting in clotting anomalies and can have devastating sequelae, including stroke, deep venous thrombosis, pulmonary embolism, and recurrent spontaneous abortions. However, cutaneous manifestations are the first sign of APS in up to 41% of patients. We present a case report of APS that developed several days after taking trimethoprim/sulfamethoxazole. The clinical and pathological features of this unique presentation, differential diagnoses, and treatments are discussed.

Topics: Anti-Infective Agents; Antiphospholipid Syndrome; Autoantibodies; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Middle Aged; Thrombosis; Trimethoprim, Sulfamethoxazole Drug Combination

Antiphospholipid syndrome is an autoimmune disease that is characterised by tendency to thrombosis, obstetrical and hematological complications. Corticosteroids may be useful for therapy of some features of this syndrome, such as thrombocytopenia. Nocardia is an important opportunistic infectious agent in immunocompromised hosts, i.e. in patients taking corticosteroids. It is important to be aware of these rare complications, which are correlated with the prognosis. In this paper, we report a patient with primary anti-phospholipid syndrome treated by corticosteroid, who developed disseminated nocardiosis.

Topics: Adult; Anti-Infective Agents; Anti-Inflammatory Agents; Antiphospholipid Syndrome; Antirheumatic Agents; Ceftriaxone; Chloroquine; Female; Humans; Immunocompromised Host; Methylprednisolone; Nocardia Infections; Thrombocytopenia; Trimethoprim, Sulfamethoxazole Drug Combination