trimethoprim--sulfamethoxazole-drug-combination and Liver-Failure--Acute

Brucellosis is one of the most widespread zoonoses worldwide. It can affect any organ system, particularly the gastrointestinal system, but there is no report of acute liver failure as a brucellosis complication.. We present a case of acute liver failure secondary to brucellosis infection. A 75-year-old Hispanic man presented to a University Hospital in Chía, Colombia, with a complaint of 15 days of fatigue, weakness, decreased appetite, epigastric abdominal pain, jaundice, and 10 kg weight loss. On examination in an emergency room, abdomen palpation was normal with hepatosplenomegaly and the results of a liver function test were elevated. The diagnosis of brucellosis was confirmed by epidemiological contact and positive Rose Bengal agglutination with negative enzyme-linked immunosorbent assay immunoglobulin M for Brucella. He was then treated with doxycycline plus trimethoprim/sulfamethoxazole, with a favorable clinical outcome.. The clinical presentation of brucellosis can be very imprecise because it can affect any organ system; however, there is no report of acute liver failure as a brucellosis complication. This is the first reported case in the Colombian literature of acute liver failure due to brucellosis. We found this case to be of interest because it could be taken into account for diagnosis in future appearances and we described adequate treatment and actions to be taken at presentation.

Topics: Aged; Animal Husbandry; Anti-Bacterial Agents; Brucella melitensis; Brucellosis; Colombia; Doxycycline; Enzyme-Linked Immunosorbent Assay; Humans; Liver Failure, Acute; Liver Function Tests; Male; Occupational Diseases; Rose Bengal; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Toxoplasmosis may be transferred by organ transplantation. The most common clinical presentation is with multisystem disease, although isolated ocular toxoplasmosis has been described. Many centers have suggested that universal use of co-trimoxazole prophylaxis obviates the need for specific Toxoplasma testing. We report a case of donor-acquired ocular toxoplasmosis after liver transplantation despite co-trimoxazole prophylaxis. The diagnosis was confirmed by Toxoplasma polymerase chain reaction assay in conjunction with seroconversion. The fact that the infection was donor acquired was confirmed by serological mismatch and the absence of sporozoite-specific antigen antibody in the recipient.

Topics: Adult; Allografts; Antibiotic Prophylaxis; Antigens, Protozoan; Antiprotozoal Agents; Chorioretinitis; Diagnosis, Differential; Female; Humans; Immunosuppression Therapy; Liver Failure, Acute; Liver Transplantation; Polymerase Chain Reaction; Seroconversion; Serologic Tests; Toxoplasma; Toxoplasmosis, Ocular; Transplantation, Homologous; Trimethoprim, Sulfamethoxazole Drug Combination

Trimethoprim-sulfamethoxazole (TMP-SMZ) is a commonly used antibiotic that has been associated with drug rash with eosinophilia and systemic symptoms (DRESS) syndrome. DRESS syndrome is characterised by fever, rash, lymphadenopathy, eosinophilia and one or more major organ involvement. Although rare, TMP-SMZ is a recognised cause of fulminant hepatic failure. We report a 17-year-old Chinese male adolescent who presented with fever, myalgia, generalised maculopapular rash and lymphadenopathy after taking TMP-SMZ for acne vulgaris. He subsequently developed hepatic encephalopathy and was worked up for urgent liver transplantation. He responded well to extracorporeal liver dialysis (originally intended as a bridging therapy) and subsequently recovered without the need for liver transplantation. This case report highlights the importance of early recognition of TMP-SMZ-induced DRESS syndrome and the need for early discontinuation of the drug in the affected patient. Extracorporeal liver dialysis and transplantation should be considered in the management of TMP-SMZ-induced fulminant hepatic failure.

Topics: Acne Vulgaris; Adolescent; Anti-Infective Agents; Biopsy; Drug Eruptions; Drug Hypersensitivity Syndrome; Fever; Humans; Liver Failure, Acute; Lymphatic Diseases; Male; Myalgia; Renal Dialysis; Skin; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination