trimethoprim--sulfamethoxazole-drug-combination and Hypotension

The clinical features of three patients with a life-threatening reaction to trimethoprim-sulfamethoxazole (TMP-SMZ) are presented along with seven other cases from the literature. All patients developed sudden fever and hypotension immediately after the administration of TMP-SMZ; usually this reaction occurred within approximately 2 weeks of completion of a previous course of the drug. All but one patient had a rash. Most patients were hypoxemic and developed diffuse pulmonary infiltrates. All patients responded rapidly to supportive care, while bacterial cultures remained negative. The presence, absence, or character of previous adverse reactions to TMP-SMZ did not predict subsequent severe reactions. Although its mechanism remains unclear, this reaction has features of both IgE-mediated anaphylaxis and cytokine (tumor necrosis factor)-mediated effects. We advise extreme caution, with close observation, when this drug is first readministered to patients who have experienced any TMP-SMZ-associated toxicity within the previous 6-8 weeks.

Topics: Adult; Diarrhea; Dyspnea; Fever; HIV Infections; Humans; Hypotension; Hypoxia; Male; Middle Aged; Pneumonia, Pneumocystis; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: AIDS-Related Opportunistic Infections; Anti-Bacterial Agents; Anti-HIV Agents; Bone Marrow Diseases; Diarrhea; Duodenal Diseases; Edema; Enteral Nutrition; Humans; Hypotension; Leg; Male; Middle Aged; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Drug Hypersensitivity; Fever; Heart Arrest; HIV Infections; Humans; Hypotension; Infant; Male; Respiratory Insufficiency; Tachycardia; Trimethoprim, Sulfamethoxazole Drug Combination

An unusual acute hypotensive syndrome has been observed in association with administration of trimethoprim-sulfamethoxazole (TMP-SMZ) to patients with human immunodeficiency virus (HIV) infection. In the 11 cases that have been reported, the syndrome differs from classic anaphylaxis and resembles septic shock. Mediation by tumor necrosis factor (TNF) has been hypothesized, but the mechanism has not been characterized with cytokine assays, and no invasive hemodynamic measurements have been reported. We describe a case of recurrent hyperdynamic shock--without classic features of anaphylaxis, without detectable IgE antibodies against TMP or SMZ, and without detectable levels of TNF--involving an HIV-infected patient rechallenged with TMP-SMZ.

Topics: Adult; AIDS-Related Opportunistic Infections; Anaphylaxis; Complement System Proteins; Fever; Hemodynamics; Humans; Hypotension; Interleukin-6; Male; Pneumonia, Pneumocystis; Shock; Trimethoprim, Sulfamethoxazole Drug Combination; Tumor Necrosis Factor-alpha

Topics: Acute Disease; Adult; Humans; Hypotension; Male; Trimethoprim, Sulfamethoxazole Drug Combination