trimethoprim--sulfamethoxazole-drug-combination and Methemoglobinemia

Topics: Drug Combinations; Humans; Male; Methemoglobinemia; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Trimethoprim-sulfamethoxazole (TMP-SMX) and phenazopyridine are individually associated with methemoglobinemia through a series of altered reduction-oxidation reactions. We report a case of methemoglobinemia associated with concurrent use of TMP/SMX and phenazopyridine in a 70-year-old woman with recurrent urinary tract infections. She presented to the emergency department for worsening back pain in the setting of recurrent urinary tract infections, concerning for pyelonephritis. During her workup, she became acutely hypoxic. The emergency department provider suspected the presence of abnormal hemoglobin. An arterial blood gas showing elevated levels of methemoglobinemia confirmed the suspicion. The combined use of TMP/SMX and phenazopyridine was thought to be the likely etiology of hypoxia. This case highlights the importance of medication management in the geriatric population, as well as the judicious use of antibiotics for urinary tract infections-a common chief complaint in the primary care setting.

Topics: Aged; Eating; Female; Humans; Methemoglobinemia; Phenazopyridine; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Methotrexate monotherapy is a common management strategy in rheumatoid arthritis (RA). Treatment with immunosuppression can lead to opportunistic infections such as Pneumocystis jirovecii pneumonia (PJP). The treatment options for PJP include cotrimoxazole, clindamycin-primaquine and dapsone. Though these drugs are generally well tolerated, they can result in potentially severe adverse effects. Sometimes several undesired events may occur in a single patient, reminding us of Murphy's law. Herein, we report a case which exemplifies this adage. A 50-year-old female developed PJP, while on methotrexate therapy for RA and was treated with cotrimoxazole. The latter resulted in painful peripheral neuropathy, which improved after cotrimoxazole was stopped. Salvage therapy for PJP with primaquine-clindamycin, lead to another serious adverse event, methemoglobinemia. Withdrawing the offending drug resulted in dramatic improvement.

Topics: Anti-Bacterial Agents; Antimalarials; Clindamycin; Dapsone; Drug Therapy, Combination; Female; Humans; Law Enforcement; Methemoglobinemia; Middle Aged; New Zealand; Peripheral Nervous System Diseases; Pneumonia, Pneumocystis; Primaquine; Trimethoprim, Sulfamethoxazole Drug Combination; Withholding Treatment

Topics: Humans; Methemoglobinemia; New Zealand; Peripheral Nervous System Diseases; Pneumonia, Pneumocystis; Primaquine; Trimethoprim, Sulfamethoxazole Drug Combination

Methemoglobinemia is a rare condition with serious consequences if not diagnosed. We report the case of a 64-year-old woman with a history of allergy to sulfa drugs and a recent diagnosis of a small vessel vasculitis (ANCA-p) who started induction therapy with corticosteroids and rituximab. Due to the need for infectious prophylaxis, and considering her history, dapsone was administered instead of cotrimoxazole after ruling out glucose-6-phosphate dehydrogenase deficiency. During the admission to the hospital for her second dose of rituximab, and while being asymptomatic, she persistently presented a pulse oximetry ≪ 90% despite the administration of O2. Therefore, the infusion was postponed to study the patient. The arterial gasometric study by direct potentiometry revealed an O2 saturation of 98%, with a saturation gap > 5%. Considering the use of dapsone, a methemoglobinemia was suspected and confirmed by co-oximetry (methemoglobinemia 9%). Dapsone was suspended and one week later, her methemoglobinemia was absent.

Topics: Dapsone; Female; Humans; Methemoglobinemia; Middle Aged; Rituximab; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Antibiotic Prophylaxis; Antifungal Agents; Child; Humans; Immunocompromised Host; Male; Methemoglobinemia; Pneumonia, Pneumocystis; Trimethoprim, Sulfamethoxazole Drug Combination

BACKGROUND Methemoglobinemia due to the administration of sulfamethoxazole/trimethoprim has been documented in a series of case reports. However, all of these reports are on adult patients, and all patients received at least daily administration of sulfamethoxazole/trimethoprim for the treatment of active or suspected infection. CASE REPORT Herein we report the development of methemoglobinemia in a pediatric patient receiving sulfamethoxazole/trimethoprim three times weekly for the prophylaxis of opportunistic infections. CONCLUSIONS The clinician should always consider sulfamethoxazole/trimethoprim, even when administered for opportunistic infection prophylaxis at reduced doses and intervals, as a possible cause of methemoglobinemia.

Topics: Humans; Infant; Leukemia, Myelomonocytic, Juvenile; Male; Methemoglobinemia; Opportunistic Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Diaphenylsulfone (DDS: Dapsone) is used for Pneumocystis pneumonia (PCP) prophylaxis, and methemoglobinemia has rarely been reported as a side effect of DDS. We herein report two cases of DDS-related methemoglobinemia in an 81-year-old man with organizing pneumonia and an 84-year-old woman with eosinophilic pneumonia under treatment with prednisolone. Both patients initially received trimethoprim/sulfamethoxazole for PCP prophylaxis and were switched to DDS due to side effects and subsequently exhibited a clinically unexplainable decrease in SpO2. Methemoglobinemia was diagnosed based on the findings of arterial blood gas analyses. In both cases, the methemoglobinemia improved after discontinuing DDS.

Topics: Aged, 80 and over; Anti-Infective Agents; Antibiotic Prophylaxis; Cryptogenic Organizing Pneumonia; Dapsone; Female; Humans; Male; Methemoglobinemia; Pneumonia, Pneumocystis; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Drug-induced methemoglobinemia is a well-described entity but has not been previously associated with elevated troponins in the absence of cardiac symptoms. We report a case of a patient presenting to the emergency department (ED) with complaints related to an exacerbation of her long-standing cystitis. A low pulse oximetry reading prompted an evaluation, revealing a troponin leak, which peaked at 10 hours. Her methemoglobin level was found to be elevated at 11.4%, but a preexisting anemia apparently prevented the clinical recognition of cyanosis. The methemoglobinemia was determined to be secondary to her ingestion of phenazopyridine and trimethoprim-sulfa methoxizole. Although phenazopyridine and sulfa agents have long been known to cause methemoglobinemia, our patient exhibited an asymptomatic troponin leak that has not been previously reported as a complication of drug-induced methemoglobinemia. Clinicians should be aware of this potential association.

Topics: Anesthetics, Local; Anti-Infective Agents, Urinary; Cystitis, Interstitial; Female; Humans; Methemoglobinemia; Middle Aged; Myocardial Ischemia; Phenazopyridine; Trimethoprim, Sulfamethoxazole Drug Combination; Troponin I

Topics: Anesthetics, Local; Anti-Infective Agents, Urinary; Cystitis, Interstitial; Female; Humans; Methemoglobinemia; Myocardial Ischemia; Phenazopyridine; Trimethoprim, Sulfamethoxazole Drug Combination; Troponin I

Topics: Anesthetics, Local; Anti-Infective Agents, Urinary; Cystitis, Interstitial; Female; Humans; Methemoglobinemia; Myocardial Ischemia; Phenazopyridine; Trimethoprim, Sulfamethoxazole Drug Combination; Troponin I

We herein report a case of methemoglobinemia induced by trimethoprim-sulfamethoxazole (TMP/SMX). A 41-year-old woman with systemic lupus erythematosus (SLE) received TMP/SMX for prophylaxis of pneumocystis pneumonia (PCP) on the 7th day of hospitalization. She suddenly developed dyspnea and cyanosis on the 9th day of hospitalization. The level of oxygen saturation (SaO2) decreased, and the concentration of methemoglobin (MetHb) in the blood was elevated. We diagnosed the patient with methemoglobinemia induced by TMP/SMX. Methemoglobinemia should be considered in cases of sudden dyspnea following TMP/SMX administration.

Topics: Adult; Anti-Infective Agents; Female; Humans; Immunosuppressive Agents; Lupus Erythematosus, Systemic; Methemoglobinemia; Pneumonia, Pneumocystis; Trimethoprim, Sulfamethoxazole Drug Combination; Withholding Treatment

The authors present a case of a 28-year-old woman on trimethoprim/sulfamethoxazole for 9 months, who presented to the emergency department with weakness, shortness of breath, and cyanosis. The patient's clinical course is outlined. A discussion of the potential etiologies, as well as the clinical management, is provided.

Topics: Adult; Anti-Infective Agents; Diagnosis, Differential; Dyspnea; Female; Humans; Methemoglobinemia; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Aged; Anti-Infective Agents; HIV Infections; Humans; Male; Methemoglobinemia; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Administration, Inhalation; Brain Neoplasms; Drug Therapy, Combination; Female; Humans; Infant; Methemoglobinemia; Neuroblastoma; Nitric Oxide; Pneumonia, Pneumocystis; Trimethoprim, Sulfamethoxazole Drug Combination

To determine whether HIV-infected patients have a deficiency of intracellular glutathione (GSH) in peripheral blood mononuclear cells (PBMC) and erythrocytes.. Initial experiments determining the stability of intracellular GSH preceded the measurement of GSH levels in 33 HIV-positive patients and 40 control subjects within 1 h of isolation of their blood cells. In addition, the susceptibility of erythrocytes to dapsone hydroxylamine-induced methaemoglobinaemia was evaluated.. GSH levels were determined by an high-performance liquid chromatography method utilizing a fluorescent probe, monobromobimane. The bimane-GSH adduct formed in PBMC was also characterized by mass spectrometry. Methaemoglobin formation on exposure to dapsone hydroxylamine was determined spectrophotometrically.. GSH levels remained stable for only 1 h after cell isolation, thereafter showing a decrease of 20 and 60% at 4 and 24H, respectively, There was no difference in the GSH levels in PBMC and erythrocytes of the HIV-positive patients compared with controls. The GSH levels were not related to the disease stage or to CD4+ cell counts. There was no difference in GSH levels in PBMC taken from trimethoprim-sulphamethoxazole-hypersensitive and non-hypersensitive patients. Methaemoglobinaemia on exposure of erythrocytes to dapsone hydroxylamine was concentration-dependent, but there was no significant difference between patients and controls.. In contrast to previous studies, no deficiency of intracellular GSH in the PBMC and erythrocytes of HIV-infected patients was found. The discrepancy between studies may be methodological reflecting the instability of GSH, which requires prompt sample analysis.

Topics: Adult; Aged; CD4 Lymphocyte Count; Dapsone; Drug Hypersensitivity; Erythrocytes; Glutathione; HIV Infections; Humans; Leukocytes, Mononuclear; Male; Methemoglobinemia; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination