trimethoprim--sulfamethoxazole-drug-combination and Hepatitis--Alcoholic

Severe alcoholic hepatitis (AH) has a very high mortality rate. Current guidelines recommend oral corticosteroids as first-line agents in individuals with severe AH to reduce short-term mortality. However, systemic corticosteroids have serious adverse effects. In individuals with AH, infection, which is one of the complications of steroid use, can result in serious outcomes, such as acute-on-chronic liver failure. Pneumocystis pneumonia (PCP) is a life-threatening opportunistic infection which may occur when high-dose corticosteroids are prescribed for more than 1 month. Therefore, when high-dose corticosteroids are used, providing PCP prophylaxis is warranted. Although trimethoprim-sulfamethoxazole (TMP-SMX) is the drug of choice for the prophylaxis of PCP, its hepatotoxicity limits its use in patients with severe AH who are on high-dose corticosteroids. Moreover, there is a lack of consensus on which drugs should be used for PCP prophylaxis in individuals with severe AH who are on glucocorticoid treatment. Herein, we report a case of a 43-year-old male with fatal PCP that occurred after the use of corticosteroids for severe AH.. A 43-year-old alcoholic man presented with a hematoma on his right leg. His liver function was poor, and he was he was diagnosed with severe AH and treated with oral corticosteroids for 26 days. After glucocorticoid treatment, he developed a productive cough.. A sputum PCR test was positive for Pneumocystis jirovecii.. He was initially treated with TMP-SMX and required artificial ventilation.. He developed disseminated intravascular coagulation and multi-organ failure, and died 10 days after starting TMP-SMX.. To date, prevention of PCP in individuals with severe AH who are on corticosteroids has been overlooked. This case illustrates the need for prophylaxis of PCP in individuals with severe AH taking corticosteroids.

Topics: Adult; Hepatitis, Alcoholic; Humans; Male; Methylprednisolone; Opportunistic Infections; Pneumocystis carinii; Pneumonia, Pneumocystis; Trimethoprim, Sulfamethoxazole Drug Combination

We report a patient who presented 6 months after orthotopic liver transplantation (OLT) with fever, dyspnea, and pulmonary infiltrates with biopsy-confirmed Pneumocystis jiroveci infection associated with a process of bronchiolitis obliterans organizing pneumonia (BOOP). We present this second case of BOOP associated with P. carinii pneumonia after OLT to highlight the risk of such disease combination in all transplant patients as well as discuss the protective effect of post-transplant prednisolone with trimethoprim-sulfamethoxazole prophylaxis and the possible duration of prophylaxis.

Topics: Anti-Infective Agents; Anti-Inflammatory Agents; Biopsy; Cryptogenic Organizing Pneumonia; Diagnosis, Differential; Drug Therapy, Combination; Hepatitis, Alcoholic; Humans; Liver Transplantation; Lung; Male; Middle Aged; Pneumocystis carinii; Pneumonia; Pneumonia, Pneumocystis; Prednisolone; Radiography; Trimethoprim, Sulfamethoxazole Drug Combination