trimethoprim--sulfamethoxazole-drug-combination and Erythema-Multiforme

Good's syndrome (GS) is a rare, adult-onset combined B cell and T cell immunodeficiency with an associated thymoma. These patients have an increased risk of bacterial, fungal, viral and opportunistic infections. This report describes a 75-year-old female patient who presented with a full body rash and an anterior mediastinal mass. She underwent a biopsy of her rash and mass, which revealed erythema multiforme and WHO Type A thymoma, respectively. During her hospitalisation, she was also found to have oropharyngeal candidiasis, methicillin-susceptible

Topics: Aged; Anti-Bacterial Agents; Cardiac Rehabilitation; Erythema Multiforme; Fatal Outcome; Female; Fluid Therapy; Humans; Immunocompromised Host; Immunologic Deficiency Syndromes; Pneumonia; Shock, Septic; Staphylococcal Infections; Thymoma; Trimethoprim, Sulfamethoxazole Drug Combination

Vemurafenib improves survival of melanoma patients. However, cutaneous side-effects commonly occur in them. Nivolumab and ipilimumab are monoclonal antibodies against programmed death 1 and cytotoxic T-lymphocyte-associated antigen 4, both of which regulate excessive T-cell activation. Although these agents induce antitumor immunity against melanoma, the modified immune condition may result in an unexpected adverse reaction which has not been observed previously. Herein, we report a case who manifested severe erythema multiforme-like eruption with mucosal involvement associated with vemurafenib following nivolumab. The patient also subsequently suffered from ipilimumab-induced interstitial pneumonia with refractory course. Such a case has never been reported. This case suggested that dermatologists should pay special attention to unexpected adverse events of these drugs, and carefully observe cutaneous and respiratory status of patients during the treatment of melanoma.

Topics: Adult; Antibodies, Monoclonal; Antineoplastic Agents, Immunological; Biopsy; Chemotherapy, Adjuvant; CTLA-4 Antigen; Drug Eruptions; Drug Resistance; Erythema Multiforme; Fever; Glucocorticoids; Humans; Indoles; Ipilimumab; Lung Diseases, Interstitial; Lymphatic Metastasis; Male; Melanoma; Mutation; Neoplasm Recurrence, Local; Nivolumab; Parotid Neoplasms; Programmed Cell Death 1 Receptor; Proto-Oncogene Proteins B-raf; Pulse Therapy, Drug; Skin Neoplasms; Sulfonamides; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination; Vemurafenib; Withholding Treatment

1) Lyell syndrome is characterised by toxic epidermal necrolysis in which epidermal detachment affects more than 30% of the body surface area. Stevens-Johnson syndrome is a minor form affecting less than 10% of the body surface area; 2) Patients who present with these cutaneous symptoms, along with throat pain, red eyes and a damaged or detached oral mucosa must be hospitalised immediately; 3) Lyell syndrome is exclusively caused by drugs while Stevens-Johnson syndrome can also be caused by bacteria and viruses. Rapid withdrawal of the drug improves prognosis.

Topics: Allopurinol; Anti-Infective Agents; Anti-Inflammatory Agents; Anticonvulsants; Erythema Multiforme; Humans; Stevens-Johnson Syndrome; Sulfonamides; Trimethoprim, Sulfamethoxazole Drug Combination

Adverse skin reactions to drugs are frequent, with rates of reaction to many commonly used drugs exceeding 1%. We describe a 29-year-old woman admitted with a history of itching, rash, vesicles on her hands and soles, and edema on her tongue and oropharynx after trimethoprim-sulfamethoxazole, ciprofloxacin, methenamine anhydromethylene citrate, piroxicam, azithromycin, and ceftriaxone intake. Erythema multiforme (EM) was diagnosed by skin biopsy after oral challenge with piroxicam. EM lesions reappeared after oral challenge with levofloxacin. Although EM is quite common with trimethoprim-sulfamethoxazole and there are some reports of EM appearing after intake of ciprofloxacin, it has rarely been attributed to piroxicam and no reports have identified levofloxacin as a cause.

Topics: Adult; Anti-Infective Agents; Anti-Inflammatory Agents, Non-Steroidal; Azithromycin; Ceftriaxone; Ciprofloxacin; Drug Hypersensitivity; Erythema Multiforme; Female; Humans; Levofloxacin; Methenamine; Ofloxacin; Piroxicam; Skin Tests; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Trimethoprim-sulfamethoxazole is a commonly used medication. Side effects are numerous and include drug hypersensitivity syndrome. The case of a 24-year-old woman with severe liver failure is presented. Erythema multiforme and thrombocytopenia developed after the acute onset of hepatotoxicity and after all medications had been stopped. Clinical resolution of all features occurred over weeks but laboratory abnormalities persisted up to eight months later. A causal link with sulfamethoxazole was supported by timing, liver biopsy and lymphocyte toxicity test. This case illustrates one presentation and the possible severity of the drug hypersensitivity syndrome associated with trimethoprim-sulfamethoxazole.

Topics: Adult; Anti-Infective Agents; Diagnosis, Differential; Drug Hypersensitivity; Erythema Multiforme; Hepatitis A; Humans; Liver Failure; Male; Syndrome; Thrombocytopenia; Trimethoprim, Sulfamethoxazole Drug Combination

The objective of this study was to quantify the risk of serious blood and skin disorders associated with co-trimoxazole.. We conducted a population-based cohort study of serious blood and skin disorders requiring hospitalization among otherwise healthy users of co-trimoxazole at Group Health Cooperative and Puget Sound (GHC).. During the years 1987 to 1993 we found six cases of co-trimoxazole-associated blood disorders and three cases of co-trimoxazole-associated skin disorders yielding risks of 5.6/100,000 (95% CI 2.6-12.2) and 2.8/100,000 (95% CI 0.9-8.2) respectively. In all cases found there was prompt recovery after discontinuation of co-trimoxazole. We found no cases of toxic epidermal necrolysis.. We conclude that the risk of blood and skin disorders associated with the use of co-trimoxazole leading to hospitalization is low.

Topics: Adult; Aged; Anti-Infective Agents; Child, Preschool; Cohort Studies; Erythema Multiforme; Female; Hematologic Diseases; Hospitalization; Humans; Leukopenia; Longitudinal Studies; Male; Middle Aged; Neutropenia; Pancytopenia; Risk Assessment; Skin Diseases; Stevens-Johnson Syndrome; Thrombocytopenia; Trimethoprim, Sulfamethoxazole Drug Combination

To quantify the risk of serious blood and skin disorders requiring hospitalization among otherwise healthy users of co-trimoxazole.. We conducted a population-based cohort study at Group Health Cooperative of Puget Sound (GHC).. During the years 1987 to 1993 we found six cases of co-trimoxazole-associated blood disorders and three cases of co-trimoxazole-associated skin disorders yielding risks of 5.6/100,000 (95% CI 2.6-12.2) and 2.8/100,000 (95% CI 0.9-8.2) respectively. In all cases found there was prompt recovery after discontinuation of co-trimoxazole. We found no cases of toxic epidermal necrolysis.. We conclude that the risk of blood and skin disorders associated with the use of co-trimoxazole leading to hospitalization is low.

Topics: Adult; Aged; Anti-Infective Agents; Child, Preschool; Cohort Studies; Erythema Multiforme; Female; Hematologic Diseases; Hospitalization; Humans; Leukopenia; Longitudinal Studies; Male; Middle Aged; Neutropenia; Pancytopenia; Product Surveillance, Postmarketing; Risk Assessment; Skin Diseases; Stevens-Johnson Syndrome; Thrombocytopenia; Trimethoprim, Sulfamethoxazole Drug Combination

One hundred and thirty seven adults with adverse cutaneous reactions to systemic drugs seen in two referral centres in northern Saudi Arabia, over a period of three years were reviewed. Urticaria, sometimes occurring with angioedema was the most common pattern observed. It was seen in 35% of cases and the culprit drugs in most instances were the salicylates and the penicillins. The combination of trimethoprim and sulfamethoxazole was the culprit drug in 70% of cases of fixed drug eruptions and 75% of cases of erythema multiforme. Although there were no recorded fatalities, there was prolonged morbidity in patients with the Stevens-Johnson's syndrome, and unsightly residual hyperpigmentations in those with fixed drug eruptions. The occurrence of these adverse reactions were frequently associated with inappropriate polypharmacy and this practice should be discouraged.

Topics: Adult; Drug Eruptions; Erythema Multiforme; Female; Humans; Male; Middle Aged; Penicillins; Referral and Consultation; Retrospective Studies; Salicylates; Saudi Arabia; Trimethoprim, Sulfamethoxazole Drug Combination

Various types of cutaneous drug eruptions and the incriminating drugs were analyzed in 50 children and adolescents up to 18 years of age (34 or 65% boys, 16 or 32% girls). Thirteen (26%) patients had a maculopapular rash, 11 (22%) a fixed drug eruption (FDE), 10 erythema multiforme (EM), 6 (12%) toxic epidermal necrolysis (TEN), 5 (10%) Stevens-Johnson syndrome (SJS), 3 (6%) urticaria, and 2 (4%) erythroderma. The incubation period for maculopapular rashes, SJS and TEN due to commonly used antibiotics and sulfonamides was short, a few hours to two to three days, reflecting reexposure, and for drugs used sparingly such as antiepileptics and antituberculosis agents, was approximately one week or more, suggesting a first exposure. Antibiotics were responsible for cutaneous eruptions in 27 patients, followed by antiepileptics in 17, analgin in 4, and metronidazole and albendazole in 1 each. Cotrimoxazole, a combination of sulfamethoxazole and trimethoprim, was the most common antibacterial responsible for eruptions (11 patients), followed by penicillin and its semisynthetic derivatives (8 patients), sulfonamide alone (3 patients), and other antibiotics (4 patients). Antiepileptics were the most frequently incriminated drugs in EM, TEN, and SJS. The role of systemic corticosteroids in the management of SJS and TEN is controversial. We administered prednisolone or an equivalent corticosteroid 2 mg/kg/day for 7 to 14 days.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Anti-Bacterial Agents; Anticonvulsants; Antitubercular Agents; Case-Control Studies; Child; Child, Preschool; Dermatitis, Exfoliative; Dipyrone; Drug Eruptions; Erythema Multiforme; Female; Humans; India; Infant; Male; Penicillins; Prednisolone; Prospective Studies; Stevens-Johnson Syndrome; Sulfonamides; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urticaria

An attempt was made to estimate the risk of severe cutaneous adverse reactions (SCARs) to Fansidar (sulfadoxine plus pyrimethamine). Cases were identified through a spontaneous reporting system. Persons exposed were estimated using sales data of 27 countries reporting one SCAR case for either Fansidar or a related product, Bactrim (cotrimoxazole; sulfamethoxazole plus trimethoprim). Between 1974 and 1989, 126 cases were notified for Fansidar: 87 cases of erythema multiforme or Stevens-Johnson syndrome, and 39 cases of toxic epidermic necrolysis. 86% of cases were reported in Europe or North America. In 116 cases with use known, prophylaxis was the reason in 103, and treatment in 13. Toxic epidermolysis and erythema multiforme/Stevens-Johnson syndrome had case fatalities of 36 (95% confidence intervals 21 to 53%) and 9% (4 to 18%), respectively. Fansidar users were estimated at 117 million, and the overall SCAR risk to be 1.1 (0.9 to 1.3) per million. For developing countries with mainly single dose use, the risk was estimated to 0.1 (0.0 to 0.1) per million. For Europe and North America with mainly prophylactic use, the risk was 10 (8 to 12) and 36 (23 to 48) per million, respectively. Prophylactic use had a 40 times higher risk than single dose therapeutic use. The aggregated risk peaked in 1984-1985, with global and North American SCAR frequencies of 3.4 (2.4 to 4.3) and 72 (41 to 102) per million, respectively. After 1985, North America reported only one further case despite continued use by an estimated 0.3 million persons.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adverse Drug Reaction Reporting Systems; Antimalarials; Drug Combinations; Drug Eruptions; Drug Utilization; Erythema Multiforme; Humans; Malaria; Pyrimethamine; Risk Factors; Stevens-Johnson Syndrome; Sulfadoxine; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination

A 78-yr-old man experienced a generalized bullous eruption of the skin (a Stevens-Johnson variant of erythema multiforme) with simultaneous involvement of the esophagus due to co-trimoxazole. Immunologic tests revealed specific antibodies of the immunoglobulin G class but not of the immunoglobulin E class against sulfamethoxazole, and in particular against trimethoprim. Lymphocyte transformation tests demonstrated sensitized lymphocytes against trimethoprim but not sulfamethoxazole. The esophageal mucosa showed intraepithelial vesicle formation with diffuse cytoplasmic deposits of immunoglobulin G. This adverse drug reaction involving both the skin and the esophagus appears to be immune-mediated.

Topics: Aged; Drug Combinations; Erythema Multiforme; Esophageal Diseases; Esophagus; Humans; Immunity; Immunoglobulins; Lymphocyte Activation; Male; Skin; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adolescent; Adult; Aged; Bacterial Infections; Child; Child, Preschool; Drug Combinations; Erythema Multiforme; Female; HLA Antigens; Humans; Infant; Male; Middle Aged; Mucocutaneous Lymph Node Syndrome; Mycoplasma Infections; Stevens-Johnson Syndrome; Sulfamethoxazole; Sulfonamides; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Virus Diseases