trimethoprim--sulfamethoxazole-drug-combination and Erythema

Sweet syndrome, also referred to as acute febrile neutrophilic dermatosis, is characterized by tender, red inflammatory nodules or papules that occur in association with infection, malignancy, connective tissue disease, or following exposure to certain drugs. Although drug-induced Sweet syndrome is rare, granulocyte colony-stimulating factor, all-trans-retinoic acid, and miscellaneous drugs have been implicated in causing this disorder in adults. In pediatric patients, granulocyte colony-stimulating factor, all-trans-retinoic acid, trimethoprim-sulfamethoxazole, and azathioprine have been implicated as potential causes of drug-induced Sweet syndrome. To date, six cases, including the patient reported here, have been reported in children.

Topics: Adult; Azathioprine; Child; Connective Tissue Diseases; Erythema; Fever; Granulocyte Colony-Stimulating Factor; Humans; Infections; Sweet Syndrome; Tretinoin; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Bacterial Agents; Ceftriaxone; Erythema; Humans; Immune Reconstitution Inflammatory Syndrome; Male; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination; Whipple Disease

Topics: Anti-Infective Agents; Buttocks; Drug Eruptions; Erythema; Female; Humans; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination; Vulva

A 49-year-old man with advanced HIV/AIDS on anti-retroviral therapy (HAART) and trimethoprim-sulfamethoxazole (TMP-SMX) presented with a several-month history of pruritic, erythematous, lichenified papules that coalesced into hyperkeratotic plaques on the trunk and extremities in a sun-exposed distribution. He shortly thereafter developed a progressive depigmentation over more than 80 percent of his body surface area. A biopsy specimen of an erythematous plaque on the trunk showed a superficial and mid-dermal infiltrate of lymphocytes with eosinophils, most consistent with either chronic lichenoid drug eruption or atypical lymphoproliferative disorder (ACLD) of HIV. The patient's lichenoid skin disease has persisted despite discontinuation of TMP-SMX, although it has improved partially with administration of topical glucocorticoids and acitretin. His depigmentation has continued to progress. We discuss the overlapping diagnostic entities which may be comprised by this patient's clinical disease, and highlight a unique presentation of the complex interaction between HIV infection and the skin.

Topics: Acitretin; Acquired Immunodeficiency Syndrome; Anti-HIV Agents; Antiretroviral Therapy, Highly Active; Bacteremia; Diagnosis, Differential; Disease Progression; Eczema; Erythema; Glucocorticoids; Herpes Simplex; Humans; Lichenoid Eruptions; Lymphoma, T-Cell, Cutaneous; Lymphoproliferative Disorders; Male; Middle Aged; Photosensitivity Disorders; Pseudolymphoma; Trimethoprim, Sulfamethoxazole Drug Combination; Ultraviolet Therapy; Vitiligo

Nocardia is a rare pathogen of mainly immunocomprised patients. Only two cases of nocardiosis have previously been identified in Iceland.. A 92-year-old male on glucocorticoid therapy with metastatic bladder cancer presented with two weeks history of progressive swelling and erythema of the hand and deteriorating cognitive functioning. A brain lesion and pulmonary nodules were identified and Nocardia farcinia was cultured from a hand abscess. The patient was initially treated with trimethoprim/sulfamethoxazole but because of rapid deterioration and old age an end-of-life decision was made.. This case of nocardiosis illustrates the importance of uncommon opportunistic infections in immunocompromised Icelandic patients.

Topics: Aged, 80 and over; Anti-Infective Agents; Cellulitis; Edema; Erythema; Glucocorticoids; Hand; Humans; Immunocompromised Host; Male; Nocardia; Nocardia Infections; Opportunistic Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder Neoplasms

The case of Mr M, a previously healthy 39-year-old man with erythema and swelling of his finger, illustrates the issues involved in treating community-acquired skin and soft tissue infections since the emergence of methicillin-resistant Staphylococcus aureus (MRSA) in the community. Most community-acquired infections of the skin and soft tissues are caused by S aureus or Streptococcus pyogenes. Until recently, infections due to such organisms in the United States could safely be treated with an oral antistaphylococcal penicillin or an oral first-generation cephalosporin. However, the emergence of methicillin-resistant staphylococci as community-acquired pathogens has changed the picture as far as empirical therapy is concerned. Not only do community-acquired MRSA bacteria cause furunculitis and cellulitis, they have also been involved in a variety of more serious and life-threatening infections. Most of these organisms are susceptible to trimethoprim-sulfamethoxazole, minocycline, doxycycline, and rifampin, and these agents, along with clindamycin, have been used in the therapy of such infections, even though no clinical trials have proven their efficacy. For more serious, life-threatening infections, linezolid or parenteral agents such as vancomycin or daptomycin should be considered.

Topics: Adult; Anti-Bacterial Agents; Cellulitis; Community-Acquired Infections; Drainage; Drug Resistance, Bacterial; Erythema; Humans; Inflammation; Infusions, Intravenous; Male; Methicillin Resistance; Penicillins; Recurrence; Risk Factors; Skin Diseases, Bacterial; Staphylococcal Skin Infections; Staphylococcus aureus; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Erythema; Humans; Hyperpigmentation; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination; Tunisia

A 20-year-old Japanese woman (Case 1) and a 70-year-old Japanese man (Case 2) consulted us with slight fever and disseminated erythematous papules. Examinations revealed that the first case was a skin eruption due to trimethoprim itself and the second was due to both trimethoprim and sulphamethoxazole. To our knowledge, our Case 1 is the first reported case with an erythematous papular type skin eruption caused by trimethoprim itself, and our Case 2 is the first case of a skin eruption in reaction to both trimethoprim and sulphamethoxazole.

Topics: Adult; Aged; Anti-Infective Agents, Urinary; Cystitis; Drug Eruptions; Erythema; Female; Humans; Male; Prostatitis; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acquired Immunodeficiency Syndrome; Erythema; Humans; Pneumonia, Pneumocystis; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Child, Preschool; Erythema; Fever; Foot Injuries; Humans; Male; Nocardia; Nocardia Infections; Skin Diseases, Bacterial; Trimethoprim, Sulfamethoxazole Drug Combination; Wound Infection; Wounds, Penetrating

Topics: Adult; Erythema; Humans; Male; Photosensitizing Agents; Skin; Trimethoprim, Sulfamethoxazole Drug Combination

We report the case of a 26-yr-old patient with fulminant liver failure and acute hemorrhagic pancreatitis secondary to the use of trimethoprim-sulfamethoxazole (Bactrim DS). Our patient presented with skin rash and decreased C3 and C4 levels, which we believed was due to a hypersensitivity reaction secondary to the sulfonamide component (sulfamethoxazole). To our knowledge, this is the first case reported in which sulfamethoxazole-trimethoprim has been implicated as a cause of fulminant liver failure and acute hemorrhagic pancreatitis simultaneously, and emphasizes the need of discontinuing this medication as soon as there is evidence of liver and pancreatic dysfunction.

Topics: Adult; Chemical and Drug Induced Liver Injury; Complement C3; Complement C4; Drug Hypersensitivity; Erythema; Hemorrhage; Humans; Male; Pancreatitis; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Anti-Infective Agents, Urinary; Drug Combinations; Erythema; Humans; Male; Pigmentation Disorders; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections