trimethoprim--sulfamethoxazole-drug-combination and Inappropriate-ADH-Syndrome

A 62 year old male non-smoker diagnosed with pulmonary nocardiosis was initiated on Cotrimoxazole therapy at a dose of 20 mg/kg per day in three divided doses. He developed hyponatremia (serum sodium 105 mEq/L) on day 3 of therapy. The potential causes of hyponatremia were evaluated. After ruling out other causes, the cause was suspected to be Cotrimoxazole-induced syndrome of inappropriate anti-diuretic hormone secretion (SIADH). We subsequently re-initiated therapy with Cotrimoxazole and the hyponatremia (serum sodium 110 mEq/L) recurred. Upon discontinuation of therapy, serum sodium levels returned to normal. The patient was started on Amoxycillin-Clavulanic Acid as an alternative therapy for pulmonary nocardiosis which resulted in resolution of the hyponatremia. Cotrimoxazole-induced SIADH is a rare occurrence. This case is representative of a patient with Cotrimoxazole-induced SIADH and the causal relationship was confirmed once resumption of therapy with the offending medi-cation resulted in hyponatremia. Clinicians should be aware of this rare adverse effect of Cotrimoxazole and should monitor serum electrolytes during therapy, especially in the elderly and in those receiving high doses.

Topics: Humans; Hyponatremia; Inappropriate ADH Syndrome; Male; Middle Aged; Nocardia Infections; Sodium; Trimethoprim, Sulfamethoxazole Drug Combination

Infection by Nocardia species is an uncommon cause of severe clinical syndromes, particularly in immunocompromised patients, and solid-organ transplantation is the most common underlying condition. The syndrome of inappropriate antidiuretic hormone secretion (SIADH) has been described thus far in lung and stem cell transplants with systemic nocardiosis.. We report the first case of SIADH in a female elderly renal transplant recipient diagnosed with systemic nocardiosis 2 years after transplantation. The SIADH was managed appropriately, and her immunosuppressive regimen remained unchanged but was adjusted at a lower level. The systemic Nocardia infection was successfully treated with intravenous administration of trimethoprim-sulfamethoxazole and imipenem for 2 weeks followed by oral trimethoprim-sulfamethoxazole for a total of 12 months.. The SIADH syndrome is a recognizable complication of Nocardia infection in renal transplant recipients. Prompt identification along with proper management and prolonged antimicrobial treatment are essential to improve patients' outcome.

Topics: Aged; Anti-Bacterial Agents; Female; Humans; Imipenem; Immunocompromised Host; Immunosuppressive Agents; Inappropriate ADH Syndrome; Kidney Transplantation; Nocardia Infections; Transplant Recipients; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Aged; Anti-Infective Agents; Arginine Vasopressin; Biomarkers; Female; Humans; Inappropriate ADH Syndrome; Incidental Findings; Osmolar Concentration; Preoperative Care; Sodium; Tooth Extraction; Trimethoprim, Sulfamethoxazole Drug Combination

We report the case of a patient with central nervous system Whipple's disease who developed the syndrome of inappropriate antidiuretic hormone secretion (SIADH). The patient did not exhibit any gastrointestinal symptoms and initially was diagnosed based on neurologic findings and a duodenal biopsy that was positive for Tropheryma whippelii by the polymerase chain reaction. Radiologic involvement of the hypothalamus suggested Whipple's disease as the likely etiology of the syndrome of inappropriate antidiuretic hormone secretion. With antimicrobial therapy, the patient's serum sodium level and symptoms showed improvement.

Topics: Actinobacteria; Duodenum; Humans; Hypothalamic Diseases; Inappropriate ADH Syndrome; Male; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination; Whipple Disease