trimethoprim--sulfamethoxazole-drug-combination and Multiple-Organ-Failure

Trimethoprim-sulfamethoxazole (TMP-SMX) hypersensitivity reaction, ranging from circulatory shock to aseptic meningitis and respiratory failure, is a potentially life-threatening condition with dermatologic relevance.. To describe the mucocutaneous findings and clinical features of TMP-SMX hypersensitivity reaction.. This was a retrospective case series study of 7 patients who developed a characteristic rash, hemodynamic changes, and end-organ dysfunction after treatment with TMP-SMX at a large university hospital system during January 2013 to March 2022.. Treatment with TMP-SMX within 2 weeks of the reaction.. Descriptions of the condition, including the demographic information of the affected population, the reaction timeline, and mucocutaneous and clinical features.. The cohort comprised 7 patients (median [range] age, 20 [15-66] years; 4 female and 3 male). The most common mucocutaneous findings were generalized sunburn-like erythema without scale, conjunctivitis, and mild facial and acral edema. Three patients had previous exposure to TMP-SMX and developed symptoms in 1 day or less, while those without prior exposure presented from 4 to 11 days after drug initiation. Among the 7 patients, 6 had fever, 7 had hypotension, and 7 had tachycardia. All patients had lymphopenia and evidence of end-organ dysfunction with either kidney or liver involvement. Median (range) time to resolution was 72 (48-96) hours.. This retrospective case series indicates that SCoRCH (sudden conjunctivitis, lymphopenia, and rash combined with hemodynamic changes) should be considered in the differential diagnosis of patients presenting with acute generalized sunburn-like erythema, conjunctivitis, systemic symptoms, and hemodynamic changes in the setting of recent TMP-SMX use.

Topics: Adult; Exanthema; Female; Humans; Hypersensitivity; Lymphopenia; Male; Multiple Organ Failure; Retrospective Studies; Sunburn; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

We describe a case of pneumonia and empyema thoracis caused by trimethoprim-sulfamethoxazole-susceptible, but imipenem-resistant Nocardia abscessus in a cancer patient. The isolate was confirmed to the species level by 16S rRNA sequencing analysis. The patient did not respond to antibiotic therapy, including ceftriaxone and imipenem, and died of progressing pneumonia and multiple organ failure.

Topics: Anti-Bacterial Agents; Ceftriaxone; Drug Resistance, Multiple, Bacterial; Empyema, Pleural; Hemangiosarcoma; Humans; Imipenem; Immunocompromised Host; Male; Middle Aged; Multiple Organ Failure; Nocardia; Nocardia Infections; Pneumonia; RNA, Ribosomal, 16S; Trimethoprim, Sulfamethoxazole Drug Combination

A 22-year-old African-American man with AIDS who had recently started on trimethoprim/sulfamethoxazole daily for pneumocystis jirovecii pneumonia prophylaxis presented with an altered mental state, malaise and nausea was found to have hepatitis, pancreatitis, rhabdomyolitis, acute kidney injury and haemolytic anaemia. Cessation of Bactrim and supportive care with volume expansion resolved his clinical symptoms and laboratory abnormalities.

Topics: Anti-Infective Agents; Humans; Male; Multiple Organ Failure; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

Topics: Acute Kidney Injury; Adenine; AIDS-Related Opportunistic Infections; Anti-HIV Agents; Antiretroviral Therapy, Highly Active; Antitubercular Agents; Fatal Outcome; Humans; Kidney Diseases; Male; Middle Aged; Multiple Organ Failure; Organophosphonates; Pneumocystis carinii; Pneumonia, Pneumocystis; Recurrence; Renal Dialysis; Tenofovir; Trimethoprim, Sulfamethoxazole Drug Combination; Tuberculosis, Renal