trimethoprim--sulfamethoxazole-drug-combination and Eosinophilia

Topics: Acute Generalized Exanthematous Pustulosis; Aged; Diagnosis, Differential; Dose-Response Relationship, Drug; Drug Eruptions; Drug Hypersensitivity Syndrome; Drug Interactions; Eosinophilia; Humans; Male; Methylprednisolone; Prescription Drugs; Prognosis; Stevens-Johnson Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination

A 56-year-old Chinese woman with previous disseminated mycobacterium avium complex infection and recurrent cervical abscesses from

Topics: Adult; Anti-Bacterial Agents; Autoantibodies; Drug Hypersensitivity Syndrome; Eosinophilia; Exanthema; Female; Humans; Immunologic Deficiency Syndromes; Interferon-gamma; Middle Aged; Mycobacterium Infections, Nontuberculous; Trimethoprim, Sulfamethoxazole Drug Combination

Diarrhea in an immunocompromised patient has a broad infectious differential. Diagnosis is difficult despite advances in diagnostic modalities. We report a case of a 45-year-old Nigerian woman who immigrated to the United States 2 years ago. She presented to the hospital with gastrointestinal bleeding, newly diagnosed HIV, and disseminated Kaposi sarcoma. During hospitalization, the patient had an onset of watery diarrhea and high eosinophilia. Subsequent stool analysis using multi-parallel real-time quantitative polymerase chain reaction for 13 parasites was positive for Cystoisospora belli. The patient was treated with trimethoprim-sulfamethoxazole, but had relapsed disease when her antibiotics were stopped prematurely. After restarting trimethoprim-sulfamethoxazole, her diarrhea and eosinophilia improved, and she had undetectable Cystoisospora belli DNA on repeat stool quantitative polymerase chain reaction. This case highlights the importance of a thorough workup for diarrhea, including parasites, especially for immunocompromised patients. Antibiotic prophylaxis is recommended in patients with Cystoisospora belli and HIV/AIDS.

Topics: Anti-Infective Agents; Diarrhea; Eosinophilia; Female; Gastrointestinal Hemorrhage; HIV Infections; Humans; Immunocompromised Host; Isospora; Isosporiasis; Middle Aged; Sarcoma, Kaposi; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

A 74-year-old man who had been administered trimethoprim-sulfamethoxazole for three weeks suffered from drug-induced hypersensitivity syndrome/drug rash with eosinophilia and systemic symptoms (DIHS/DRESS). In the early stage of the clinical course, he developed renal dysfunction. A renal biopsy showed granulomatous tubulointerstitial nephritis accompanying the proliferation of human herpes virus (HHV)-6 in tubular epithelial cells. With corticosteroid therapy, the systemic rash and renal function gradually improved. The present patient is the second case of DIHS/DRESS demonstrating a possible reactivation of HHV-6 in the renal tissue. The clinical role of viral reactivation in DIHS/DRESS must be further elucidated.

Topics: Adrenal Cortex Hormones; Aged; Anti-Bacterial Agents; Drug Hypersensitivity Syndrome; Eosinophilia; Herpesvirus 6, Human; Humans; Male; Renal Insufficiency; Trimethoprim, Sulfamethoxazole Drug Combination

Isospora belli infection, characterized by peripheral blood eosinophilia, is often seen as an opportunistic infection in patients with acquired immunodeficiency syndrome (AIDS). It is also reported in patients with underlying lymphoproliferative disorders including lymphoma and leukemia. Eosinophil-associated gastrointestinal disorders (EGID), including eosinophilic gastroenteritis (EGE), is characterized by eosinophilic infiltration of the gastrointestinal (GI) tract with various GI symptoms. We report a case of a 50-year-old male who developed Isospora superinfection of the small bowel while receiving systemic corticosteroids for EGE. He presented with worsening diarrhea, abdominal pain, nausea and vomiting with worsening peripheral eosinophilia. I. belli infection was diagnosed by the detection of oocysts in stool samples and by the presence of the parasite on duodenal biopsy in the background of tissue eosinophilia. I. belli can cause severe chronic diarrhea in immunocompromised patients on corticosteroids. Trimethoprim-sulfamethoxazole often provided rapid cure. Even though peripheral blood eosinophilia was seen in both EGE and Isospora infection, the identification of subnuclear protozoal inclusions as a new histologic finding, as well as the absence of this finding in previous duodenal biopsies coupled with the continued presence of tissue eosinophilia, favored a parasitic superinfection in the setting of underlying EGE.

Topics: Animals; Biopsy; Duodenum; Enteritis; Eosinophilia; Feces; Gastritis; Humans; Isospora; Isosporiasis; Male; Middle Aged; Superinfection; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adolescent; Adult; Allopurinol; Anti-Infective Agents; Anti-Inflammatory Agents, Non-Steroidal; Anticonvulsants; Carbamazepine; Child; Drug Combinations; Drug Eruptions; Eosinophilia; Exanthema; Female; Glucosamine; Gout Suppressants; Humans; Male; Middle Aged; Pruritus; Retrospective Studies; Sulfasalazine; Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

In some patterns of cutaneous adverse drug reactions, and depending on the culprit drug, patch testing has been helpful in confirming its cause. Its value in Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) has not been established in a large cohort of patients.. The aim of the present study is to evaluate the safety and usefulness of patch testing in DRESS.. Between January 1998 and December 2008, we studied 56 patients with DRESS induced by antiepileptic agents in 33 patients (59%), allopurinol in 19 (34%) and sulfasalazine, cotrimoxazole, tenoxicam, and amoxicillin in 1 patient each (7%).. A positive patch test reaction was observed in 18 patients (32.1%), of which 17 were with antiepileptics and 1 with tenoxicam. In the antiepileptic group, carbamazepine alone was responsible for 13 of 17 positive reactions (76.5%). Patch tests with allopurinol and its metabolite were negative in all cases attributed to this drug.. In this study, patch testing was a safe and useful method in confirming the culprit drug in DRESS induced by antiepileptic drugs, whereas it had no value in DRESS induced by allopurinol. The pathogenesis of DRESS is not yet entirely clarified, but positive patch tests suggest a drug-dependent delayed hypersensitivity mechanism.

Topics: Allopurinol; Amoxicillin; Anticonvulsants; Drug Hypersensitivity; Eosinophilia; Exanthema; Female; Humans; Male; Middle Aged; Patch Tests; Sulfasalazine; Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination

Due to the escalating rates of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infection, trimethoprim-sulfamethoxazole (TMP-SMX) is being used increasingly in the pediatric population for skin and soft tissue infections. Although this combination agent has been associated with a hypersensitivity syndrome involving cutaneous skin eruptions, pediatric cases of TMP-SMX-induced hepatotoxicity are rare. We describe a relatively healthy, 9-year-old boy who developed a CA-MRSA skin and soft tissue infection and was treated with TMP-SMX. After 14 days of therapy, he was taken to the emergency department with a 3-day history of fever, headache, and neck pain. He was diagnosed with a viral syndrome, acetaminophen was prescribed, and he was sent home. Three days later, the patient returned to the emergency department with fever, vomiting, decreased energy and appetitie, and suprapubic abdominal pain, and he was hospitalized. Laboratory test results revealed elevated liver function test values. After other potential causes of liver toxicity were excluded, TMP-SMX was determined to be the cause of his acute liver toxicity. The drug was discontinued, his symptoms resolved, and his liver function tests returned to normal. Use of the Naranjo adverse drug reaction probability scale indicated a probable relationship (score of 5) between the patient's development of hepatotoxicity and the TMP-SMX therapy. This rare adverse reaction to TMP-SMX has been reported in adults; however, to our knowledge, it has been reported in only five other children. Due to the increasing use of TMP-SMX in children, clinicians should be aware of this potentially life-threatening, immunemediated hypersensitivity reaction. Fortunately, however, the hepatotoxicity appears to resolve after discontinuation of the TMP-SMX therapy in most reported cases. This case report illustrates the importance of early detection of drug-induced hepatotoxicity and timely drug discontinuation to prevent the need for liver transplantation.

Topics: Anti-Bacterial Agents; Chemical and Drug Induced Liver Injury; Child; Drug Hypersensitivity; Early Diagnosis; Eosinophilia; Humans; Liver; Male; Methicillin-Resistant Staphylococcus aureus; Staphylococcal Infections; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

We report on a patient with Pneumocystis jirovecii pneumonia who developed fever, rash, eosinophilia and hepatitis 10 days after initiation of a therapy with sulfamethoxazole and trimethoprim. A DRESS syndrome was diagnosed and the therapy was changed successfully to pyrimethamine and dapsone. We describe the clinical picture, causative drugs, pathogenesis, differential diagnoses and therapy of this life-threatening disease to acquaint the general practitioner with it.

Topics: Antibodies, Monoclonal; Antibodies, Monoclonal, Murine-Derived; Antineoplastic Combined Chemotherapy Protocols; Cyclophosphamide; Diagnosis, Differential; Doxorubicin; Drug Eruptions; Drug Hypersensitivity; Eosinophilia; Exanthema; Fever of Unknown Origin; Humans; Liver Function Tests; Lymphoma, T-Cell; Male; Middle Aged; Opportunistic Infections; Pneumocystis carinii; Pneumonia, Pneumocystis; Prednisone; Rituximab; Trimethoprim, Sulfamethoxazole Drug Combination; Vincristine

We report on a 3-year-old Melanesian girl admitted for acute renal failure following subfulminant hepatitis A virus infection. While the child was slowly recovering from severe cytolytic hepatitis, she presented 8 weeks of protracted fever and major eosinophilia (30,000/microl); thereafter, acute renal failure (serum creatinine 295 micromol/l) occurred. Renal histology displayed diffuse eosinophilic infiltrate, with severe acute tubulointerstitial lesions associated with mild glomerular endocapillary proliferation and eosinophilic infiltrate, suggesting an immunoallergic mechanism. The child had received cefixime and cotrimoxazole 3 weeks prior to hospitalisation for the hepatitis A virus infection. The final diagnosis was of the syndrome drug reaction with eosinophilia and systemic symptoms or DRESS, induced by cefixime or cotrimoxazole and possibly triggered by the hepatitis A virus infection.

Topics: Acute Kidney Injury; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Cefixime; Child, Preschool; Drug Therapy, Combination; Eosinophilia; Female; Hepatitis A; Humans; Kidney; Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination

There are no generally accepted diagnostic criteria for primary systemic vasculitis, and the application of classification as diagnostic criteria is not feasible and may even be misleading. We report a case of a 13-year-old boy with acute abdomen who was found to have isolated eosinophilic mesenteric vasculitis with extensive thrombosis and splenic infarction. All serological tests were negative, including antineutrophil cytoplasmic antibody. The vasculitis had been successfully controlled with surgical intervention, steroid, and cyclophosphamide therapy. This may be an atypical presentation of Churg-Strauss syndrome.

Topics: Adolescent; Anti-Infective Agents; Chemotherapy, Adjuvant; Cyclophosphamide; Eosinophilia; Humans; Immunosuppressive Agents; Jejunum; Male; Mesenteric Vascular Occlusion; Mesenteric Veins; Prednisone; Splenic Infarction; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Vasculitis; Venous Thrombosis

Topics: Acquired Immunodeficiency Syndrome; Adult; Eosinophilia; Folliculitis; Humans; Isotretinoin; Keratolytic Agents; Male; Trimethoprim, Sulfamethoxazole Drug Combination

A case of cotrimoxazole-induced meningoencephalitis in an HIV-infected patient without signs of AIDS is reported. The patient developed an apparently generalized seizure, of cotrimoxazole, 1 month after first taking a dose of this drug and a febrile coma after a second dose 3 weeks later. Lumbar puncture revealed eosinophilic aseptic meningitis. The patient quickly recovered without sequelae and was given antiretroviral therapy plus pentamidine aerosolized and pyrimethamine as prophylaxis for opportunistic infections. No other adverse effects were observed. The report describes the diagnosis of this case supported by a commentary, including a literature review.

Topics: Adult; AIDS-Related Opportunistic Infections; Anti-Infective Agents; Eosinophilia; Humans; Male; Meningitis, Aseptic; Trimethoprim, Sulfamethoxazole Drug Combination

In the case reported, serial evaluation of sputum inflammatory cell counts made it possible to identify an unusual series of events in a man with eosinophilic bronchitis. The patient initially presented with a productive cough, which did not respond to treatment with antibiotics or high-dose inhaled corticosteroids. A diagnosis of eosinophilic bronchitis was made after demonstration of intense sputum eosinophilia. When inhaled corticosteroids were stopped, symptoms and sputum eosinophilia became worse and airway hyperresponsiveness developed. Both abnormalities were reversed by a course of prednisone. When the prednisone was stopped the productive cough recurred but on this occasion sputum examination suggested a different disease process and the symptoms resolved after a course of co-trimoxazole. The patient has subsequently remained well on no treatment with little or no sputum eosinophilia.

Topics: Anti-Infective Agents; Anti-Inflammatory Agents; Asthma; Bronchial Hyperreactivity; Bronchitis; Budesonide; Cough; Diagnosis, Differential; Eosinophilia; Eosinophils; Glucocorticoids; Humans; Leukocyte Count; Male; Middle Aged; Neutrophils; Prednisone; Pregnenediones; Sputum; Trimethoprim, Sulfamethoxazole Drug Combination

Muscle sarcocystosis is a parasitic infection acquired by ingestion of sporocysts of Sarcocystis species. A case is described where symptoms of fever, chronic myositis and eosinophilia were present. Diagnosis was made via muscle biopsy. Improvement and cure coincided with treatment with cotrimoxazole. A limited review of human muscle sarcocystosis and an outline of the gaps in the knowledge of this infection is presented.

Topics: Adult; Eosinophilia; Humans; Male; Myositis; Sarcocystosis; Trimethoprim, Sulfamethoxazole Drug Combination

One week after treatment of a urinary infection with co-trimoxazole (twice daily 160 mg trimethoprim and 800 mg sulphamethoxazole) a 21-year-old man suddenly started to vomit, accompanied by watery diarrhoea, abdominal swelling and weight loss of 5 kg. Plain X-ray film of the abdomen while standing showed multiple fluid levels in the small intestine of the upper and lower abdomen. Serum IgE concentration was elevated to 325 U/ml. There was a leukocytosis of 25,800/microliters, with a differential count of 45% eosinophils. Protein-rich ascites contained numerous eosinophils and the mucosa of the terminal ileus and the duodenum was infiltrated with eosinophils, findings which indicated eosinophilic gastroenteritis. All symptoms regressed completely within 10 days of stopping co-trimoxazole and administering prednisolone (50 mg/day). Four years later a similar episode of eosinophilic gastroenteritis developed after the patient had taken trimethoprim with a sulphonamide (once daily 180 mg trimethoprim and 820 mg sulphadiazine). It again quickly responded to short-term administration of glucocorticoids.

Topics: Adult; Drug Hypersensitivity; Eosinophilia; Gastroenteritis; Humans; Male; Prednisolone; Recurrence; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The incidence of hematologic abnormalities was evaluated in 120 children with otitis media treated respectively with cotrimoxazole (trimethoprim-sulfamethoxazole) (group 1), cotrimoxazole plus folinic acid (group 2) and amoxicillin (group 3) in therapeutic doses for ten days. Only eosinophilia (an absolute count greater than or equal to 0.5 X 10(9)/l) (group 1 = 10%, 2 = 5%, 3 = 7.5%) and neutropenia (polymorphonuclear neutrophilic leucocyte count less than or equal to 1.5 X 10(9)/l) (group 1 = 35%, 2 = 17.5%, 3 = 13.3%) were noted. Early neutropenia (evident on the 5th day of therapy) occurred in all the treatment groups, thus it is not related to cotrimoxazole administration and in most cases neutrophil count reversed to normal in few days without drug discontinuation. Late neutropenia (evident after 10 days of treatment) appeared only in cotrimoxazole treated children (p less than 0.05). No superimposed bacterial infection was demonstrated in any case. Late neutropenia seems to be strictly related to the sequential blockage of folinic acid metabolism and can be prevented by the concomitant administration of folinic acid.

Topics: Agranulocytosis; Amoxicillin; Child; Child, Preschool; Drug Combinations; Drug Therapy, Combination; Eosinophilia; Female; Folic Acid; Humans; Infant; Male; Neutropenia; Otitis Media; Risk; Sulfamethoxazole; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination