trimethoprim--sulfamethoxazole-drug-combination and Myalgia

A 24-year-old active duty soldier was evacuated from Afghanistan to the United States after persistent upper respiratory tract infection. His course was complicated by an exfoliative rash, diffuse muscle aches, and elevated creatine kinase following trimethoprim-sulfamethoxazole exposure that persisted despite withdrawal of the medication. Dermatomyositis was strongly considered, but the patient had a negative muscle biopsy and had positive serologies for acute Epstein-Barr virus infection. We present a case of acute Epstein-Barr virus infection and possible trimethoprim-sulfamethoxazole reaction mimicking dermatomyositis.

Topics: Afghan Campaign 2001-; Anti-Infective Agents; Creatine Kinase; Dermatomyositis; Diagnosis, Differential; Drug Eruptions; Exanthema; Humans; Infectious Mononucleosis; Male; Military Personnel; Myalgia; Pharyngitis; Rhabdomyolysis; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Young Adult

In May 2014, six patients presented in Germany with a Sarcocystis-associated febrile myositis syndrome after returning from Tioman Island, Malaysia. During two earlier waves of infections, in 2011 and 2012, about 100 travellers returning to various European countries from the island were affected. While the first two waves were associated with travel to Tioman Island mostly during the summer months, this current series of infections is associated with travel in early spring, possibly indicating an upcoming new epidemic.

Topics: Adolescent; Anti-Infective Agents; Child; Female; Fever; Germany; Headache; Humans; Infant; Malaysia; Male; Myalgia; Prednisolone; Sarcocystis; Sarcocystosis; Travel; 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