trimethoprim--sulfamethoxazole-drug-combination and Lupus-Nephritis

A 23-year-old Japanese woman was diagnosed with lupus nephritis on May 2007. The patient was prescribed 30 mg/day of prednisolone, but developed a pulmonary abscess and was admitted to Sapporo Medical University Hospital in March 2008. Antibiotics improved the symptoms. We prescribed trimethoprim-sulfamethoxazole as prophylaxis for pneumocystis pneumonia; however, the patient developed fever and thrombocytopenia with hyperferritinemia after a week of this prophylaxis. We considered that she was developing hemophagocytic syndrome, and administered methylprednisolone pulse therapy. The clinical findings soon improved. However, when the prophylaxis was restarted, the patient developed fever, headache, and anaphylaxis the same day. Symptomatic therapy resolved these symptoms after three days, but they recurred on recommencing trimethoprim-sulfamethoxazole. Analysis of the cerebrospinal fluid revealed aseptic meningitis. These episodes were thought to be induced by trimethoprim-sulfamethoxazole. As trimethoprim-sulfamethoxazole is frequently used as prophylaxis for pneumocystis infection in immunosuppressed patients, clinicians should be vigilant regarding the complications of this treatment, particularly the rare occurrence of aseptic meningitis and anaphylaxis.

Topics: Anaphylaxis; Anti-Infective Agents; Antibiotic Prophylaxis; Female; Humans; Immunocompromised Host; Lupus Nephritis; Meningitis, Aseptic; Pneumonia, Pneumocystis; Prednisolone; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

A 46-year-old man had been given 40mg prednisolone daily for systemic lupus erythematosus. He complained of fever and general fatigue and chest computed tomography revealed wide-spread consolidation with multiple cavity formation in his left lung. Pulmonary nocardiosis was clinically suspected because we detected nocardia from Gram staining of sputum. He was cured by sulfamethoxazole-trimethoprim, Imipenem/Cilastatin, although a cavity with a slightly thickened wall in the left lung remained. Nocardia asteroides was cultured from sputum and pulmonary nocardiosis was diagnosed. The present case was pulmonary nocardiosis that spread with multiple and extensive cavity formation. A good outcome was obtained by early treatment with sulfamethoxazole-trimethoprim.

Topics: Anti-Infective Agents; Humans; Lung Diseases; Lupus Erythematosus, Systemic; Lupus Nephritis; Male; Middle Aged; Nocardia Infections; Opportunistic Infections; Prednisolone; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Female; Humans; Kidney; Lupus Erythematosus, Systemic; Lupus Nephritis; Pneumonia, Pneumocystis; Remission Induction; Trimethoprim, Sulfamethoxazole Drug Combination