trimethoprim--sulfamethoxazole-drug-combination and Necrosis

We present magnetic resonance imaging findings of a 5-year-old girl who had a rapidly installing hemolytic anemia crisis induced by trimethoprim-sulfomethoxazole, resulting in cerebral anoxia leading to permanent damage. Magnetic Resonance imaging revealed cortical laminar necrosis in arterial border zones in both cerebral hemispheres, ischemic changes in subcortical white matter of left cerebral hemisphere, and in the left putamen. Although cortical laminar necrosis is a classic entity in adulthood related to conditions of energy depletions, there are few reports available in children. A wide review of the literature is also presented.

Topics: Anemia, Hemolytic; Anti-Infective Agents; Arnold-Chiari Malformation; Brain Ischemia; Cerebral Cortex; Child, Preschool; Epilepsy, Tonic-Clonic; Female; Humans; Hypoxia, Brain; Magnetic Resonance Imaging; Necrosis; Putamen; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination

Massive hepatic necrosis following exposure to phenytoin and trimethoprim-sulfamethoxazole is a rare occurrence and to the best of our knowledge has not been reported previously. Acute hepatic failure following administration of trimethoprim-sulfamethoxazole has rarely been seen, and only 4 cases have been well documented pathologically. We report a case of acute liver failure in a 60-year-old woman following ingestion of phenytoin and trimethoprim-sulfamethoxazole concomitantly over a 9-day period. Autopsy findings revealed acute fulminant hepatic failure. This case demonstrates the effects of chemical-chemical interactions in the potentiation of hepatotoxicity of single agents and specifically illustrates the need for discontinuing trimethoprim-sulfamethoxazole in the presence of early liver injury.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Child, Preschool; Drug Interactions; Fatal Outcome; Female; Hepatic Encephalopathy; Humans; Liver; Middle Aged; Necrosis; Phenytoin; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Aeromonas hydrophila; Animals; Anti-Infective Agents; Ciprofloxacin; Cross Infection; Drug Resistance, Multiple, Bacterial; Gram-Negative Bacterial Infections; Humans; Leeches; Leeching; Male; Middle Aged; Necrosis; Surgical Flaps; Trimethoprim, Sulfamethoxazole Drug Combination

In addition to the well-known signs of methotrexate toxicity, rare cutaneous side effects have been described. These cutaneous signs may provide a diagnostic clue into the diagnosis of toxicity as well as facilitate early and aggressive therapy. We describe the case of a 37-year-old male, with a diagnosis of psoriasis, who developed characteristic signs and symptoms of acute methotrexate toxicity after receiving an unknown amount of intravenous methotrexate. The patient experienced a distinct change in the morphology of his existing psoriatic plaques, which became ulcerated and necrotic in the week following the methotrexate injection. Shortly after the development of cutaneous erosions, the patient developed pancytopenia, which ultimately led to his death. Ulceration and necrosis of cutaneous psoriasis plaques may serve as a herald for the impending development of life-threatening pancytopenia in patients with acute methotrexate toxicity.

Topics: Acute Kidney Injury; Adult; Azithromycin; Biopsy; Fatal Outcome; Filgrastim; Granulocyte Colony-Stimulating Factor; Humans; Immunosuppressive Agents; Leucovorin; Male; Methotrexate; Mucositis; Necrosis; Pancytopenia; Plasma; Psoriasis; Recombinant Proteins; Self Medication; Skin Ulcer; Trimethoprim, Sulfamethoxazole Drug Combination

We report a 24-year-old man with a known Behcet's disease who was lost to follow-up for a year. The patient was admitted for the association of scrotal ulceration and inguinal folliculitis, suggesting a Behcet's disease flare-up. Necrotizing course of the folliculitis led to the diagnosis of skin infection caused by a community-acquired methicillin-resistant Staphylococcus aureus strain, carrying Panton-Valentine leukocidin genes. Bacteriological analysis should be mandatory in the absence of specific criteria for the diagnosis of Behcet's disease.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Anti-Infective Agents, Local; Bacterial Toxins; Behcet Syndrome; Chlorhexidine; Colchicine; Community-Acquired Infections; Diagnosis, Differential; Drug Therapy, Combination; Exotoxins; Folliculitis; Follow-Up Studies; Groin; Humans; Leg Ulcer; Leukocidins; Male; Methicillin-Resistant Staphylococcus aureus; Necrosis; Ofloxacin; Phenindione; Scrotum; Staphylococcal Skin Infections; Stomatitis, Aphthous; Time Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

Topics: Adult; Anti-Bacterial Agents; Antiretroviral Therapy, Highly Active; Combined Modality Therapy; Debridement; Drug Therapy, Combination; Female; Gingivitis; Gingivoplasty; Heroin Dependence; HIV Infections; Humans; Mandible; Methadone; Necrosis; Oral Ulcer; Pain; Stomatitis; Substance Abuse, Intravenous; Tooth Extraction; Tooth Loss; Treatment Refusal; Trimethoprim, Sulfamethoxazole Drug Combination

Kikuchi-Fujimoto disease is a rare benign cervical lymphadenopathy, which often affects young adult women. Its etiology and pathogenesis are unknown. We present the case of Kikuchi-Fujimoto disease in the Polish population and analyse the difficulties in differentiating this disease from the systemic lupus erythematosus.

Topics: Anti-Infective Agents; Anti-Inflammatory Agents; Biomarkers; Diagnosis, Differential; Female; Histiocytic Necrotizing Lymphadenitis; Humans; Lupus Erythematosus, Systemic; Lymph Nodes; Middle Aged; Necrosis; Prednisolone; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Concern persists that prednisone-free maintenance immunosuppression in kidney transplant recipients will be associated with an increase in late allograft dysfunction and graft loss. We herein report 5-year follow-up of a trial of prednisone-free maintenance immunosuppression. From October 1, 1999, through January 31, 2005, at our center, 589 kidney transplant recipients were treated with a protocol incorporating discontinuation of their prednisone on postoperative day 6. At 5 years, actuarial patient survival was 91%; graft survival, 84%; death-censored graft survival, 92%; acute rejection-free graft survival, 84% and chronic rejection-free graft survival, 87%. The mean serum creatinine level (+/-SD) at 1 year was 1.6 +/- 0.6; at 5 years, 1.7 +/- 0.8. In all, 86% of kidney recipients with functioning grafts remain prednisone-free as of April 30, 2005. As compared with historical controls, recipients on prednisone-free maintenance immunosuppression had a significantly lower rate of a number of complications, including cataracts (p < 0.001), posttransplant diabetes mellitus (p < 0.001), avascular necrosis (p = 0.001), and fractures (p = 0.004). We conclude that prednisone-related side effects can be minimized in a protocol incorporating prednisone-free maintenance immunosuppression. Five-year graft outcome remains good.

Topics: Anti-Infective Agents; Antifungal Agents; Antiviral Agents; Cataract; Clotrimazole; Cohort Studies; Creatinine; Dapsone; Diabetes Mellitus; Fractures, Bone; Ganciclovir; Graft Rejection; Graft Survival; Humans; Immunosuppression Therapy; Immunosuppressive Agents; Kidney Transplantation; Necrosis; Nystatin; Pentamidine; Prednisone; Time Factors; Transplantation, Homologous; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Valganciclovir

In a case of pediatric Whipple disease confined to the central nervous system, white matter lesions initially appeared as areas of very low signal intensity on T1-weighted MR images and as areas of hyperintensity on proton density-weighted and T2-weighted images, and showed slight peripheral enhancement on delayed contrast-enhanced T1-weighted images. On MR studies obtained 3 and 6 months after antibiotic therapy, the lesions had decreased in size and no longer enhanced. They became progressively less hypointense on T1-weighted images and less hyperintense on T2-weighted images.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Brain Diseases; Cerebellar Diseases; Child, Preschool; Chloramphenicol; Contrast Media; Follow-Up Studies; Gliosis; Humans; Image Enhancement; Magnetic Resonance Imaging; Male; Necrosis; Trimethoprim, Sulfamethoxazole Drug Combination; Whipple Disease

1. The nephrotoxicity of gentamicin is well known. However, little information is available regarding the combined effects of gentamicin plus co-trimoxazole (sulfamethoxazole-trimethoprim). Therefore, Wistar rats were treated daily with 100 mg/kg gentamicin or 100 mg/kg gentamicin plus 30 mg/kg trimethoprim-150 mg/kg sulfamethoxazole for 14 days. 2. Serum biochemical parameters were measured on days 0, 8 and 15, and histopathological examinations of kidneys were performed on day 15, one day following end of treatment. Gentamicin treated rats exhibited a 63% increase in blood urea nitrogen (BUN), a 124% increase in uric acid, and a 63% decrease in serum potassium levels on day 15. 3. The combination of gentamicin plus co-trimoxazole partially ameliorated these effects. With the three drug combination no change occurred in BUN, and only a 30% decrease occurred in serum potassium levels. 4. While serum creatinine levels significantly increased following gentamicin, the co-administration of co-trimoxazole resulted in a significant decrease (30%) in creatinine. Histopathological examinations of kidneys suggested a lower degree of nephrotoxicity in rats treated with gentamicin plus co-trimoxazole as compared to animals treated with gentamicin alone. 5. The results support the importance of monitoring serum biochemical parameters when treating with gentamicin or gentamicin plus co-trimoxazole.

Topics: Animals; Blood Urea Nitrogen; Drug Therapy, Combination; Gentamicins; Kidney; Necrosis; Potassium; Rats; Rats, Wistar; Trimethoprim, Sulfamethoxazole Drug Combination; Uric Acid

Topics: Adult; Erythema Nodosum; Humans; Leprosy, Lepromatous; Male; Necrosis; Trimethoprim, Sulfamethoxazole Drug Combination