trimethoprim--sulfamethoxazole-drug-combination and Pancreatitis

Pancreatic disease in patients with AIDS often is so mild that the diagnosis may be missed. The pancreas can be affected by systemic illness caused by opportunistic infections, Kaposi's sarcoma, or lymphoma. More commonly, drugs used to treat patients infected with human immunodeficiency virus can cause pancreatitis and result in significant morbidity and, rarely, mortality. We report one such case in a 47-year-old patient with AIDS in whom pancreatitis developed while taking 2',3'-dideoxyinosine (ddI). His condition improved on ddI withdrawal, but he suffered a fatal relapse while receiving 2',3'-dideoxycytidine and trimethoprim-sulfamethoxazole. This case gives me the opportunity to review the literature regarding the incidence, causes, and diagnosis of human immunodeficiency virus-associated pancreatitis.

Topics: Acquired Immunodeficiency Syndrome; Acute Disease; Anti-Infective Agents; Antiviral Agents; Fatal Outcome; Humans; Male; Middle Aged; Pancreatitis; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination

The pancreas is frequently involved during HIV infection, especially by disseminated infections or neoplasms. These lesions are generally asymptomatic and are discovered at autopsy. However, hypoglycaemia secondary to massive pancreatic infiltration by a tumour or tuberculous necrosis may occur. The most important cause of pancreatic dysfunction in HIV-infected patients is a drug toxic effect (intravenous pentamidine, didanosine, zalcitabine). Hypoglycaemia, which may or may not be followed by diabetes, can develop during intravenous pentamidine therapy. In cases with increased serum amylase and/or lipase levels, potentially toxic drugs must be promptly discontinued to avoid major pancreatic involvement.

Topics: Acute Disease; AIDS-Related Opportunistic Infections; Didanosine; HIV Infections; Humans; Pancreas; Pancreatic Diseases; Pancreatitis; Pentamidine; Trimethoprim, Sulfamethoxazole Drug Combination; Zalcitabine

Topics: Abdominal Pain; Administration, Oral; Amylases; Cells, Cultured; Child; Drug-Related Side Effects and Adverse Reactions; Edema; Enzyme-Linked Immunospot Assay; Female; Humans; Immunization; Lipase; Lymphocyte Activation; Pancreatitis; T-Lymphocytes, Cytotoxic; Trimethoprim, Sulfamethoxazole Drug Combination; Vomiting; Withholding Treatment

Multiple medications have been associated with pancreatitis, however, data in the pediatric population are scarce secondary to the nonspecific presentation and infrequent diagnosis. The aim of this report is to characterize drug-induced pancreatitis in an adolescent patient.. A 16-year-old African-American female presented with a surgical site infection 8 weeks after a motor vehicle accident with multiple traumas. Two weeks prior to the admission, the patient was hospitalized for a urinary tract infection (UTI) and was initiated on sulfamethoxazole/trimethoprim (TMP/SMX) daily for UTI prophylaxis. On day 13, the patient was diagnosed with acute pancreatitis with an amylase level of 187 units/L (normal = 30-110) and a lipase level of 987 units/L (normal = 23-208). TMP/SMX was discontinued, and pancreatic enzyme levels decreased but did not reach normal. The patient was asymptomatic at discharge.. TMP/SMX was identified as the likely etiology of pancreatitis by the medical team. Evaluation with the Naranjo algorithm indicated a "possible" adverse drug reaction.. Acute pancreatitis can have significant morbidity and mortality in the pediatric population but can go undiagnosed due to its lower incidence. Pediatric patients presenting with idiopathic abdominal pain should be evaluated for pancreatitis and drug therapy should be reviewed for potential causative agents.

Topics: Abdominal Pain; Accidents, Traffic; Acute Disease; Adolescent; Anti-Infective Agents, Urinary; Female; Humans; Multiple Trauma; Pancreatitis; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Some infectious organisms may give rise to acute pancreatitis; brucellosis, however, extremely rarely leads to acute pancreatitis. A 40-year-old man was diagnosed with acute pancreatitis, the etiology of which was determined to be acute brucellosis. The patient was discharged without complications approximately 15 days after the initiation of trimethoprim-sulfamethoxazole and doxycycline treatment. Brucella infections may rarely be complicated by acute pancreatitis. Thus, brucellosis should be remembered in the etiology of acute pancreatitis in regions such as Turkey, where Brucella infections are endemic.

Topics: Acute Disease; Adult; Agriculture; Brucellosis; Diagnosis, Differential; Doxycycline; Humans; Male; Pancreatitis; Trimethoprim, Sulfamethoxazole Drug Combination; Turkey

A 34-yr-old woman developed simultaneous pancreatitis and hepatitis following exposure to trimethoprim-sulfamethoxazole (TMP/SMX). The episode occurred 4 yr after a previous episode of hepatitis associated with TMP/SMX. This patient represents the second case of concurrent TMP/SMX-induced pancreatitis and hepatitis reported in the literature. However, it is the first in which the adverse reaction was documented following an inadvertent rechallenge with the drug.

Topics: Adult; Chemical and Drug Induced Liver Injury; Female; Humans; Pancreatitis; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Adult; Anti-HIV Agents; Drug Therapy, Combination; HIV Infections; HIV Protease Inhibitors; Humans; Hypertriglyceridemia; Male; Pancreatitis; Reverse Transcriptase Inhibitors; Ritonavir; Trimethoprim, Sulfamethoxazole Drug Combination; Zidovudine

Topics: Adult; Anti-Infective Agents; HIV Seropositivity; Humans; Male; Pancreatitis; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abdominal Pain; Acquired Immunodeficiency Syndrome; Acute Disease; Adult; Cholelithiasis; Cryptosporidiosis; Humans; Male; Pancreatitis; Trimethoprim, Sulfamethoxazole Drug Combination

To report a case of probable pentamidine-induced acute pancreatitis.. A patient was hospitalized because of fever, dyspnea, and productive cough. Chest X-ray revealed diffuse alveolar infiltrates, and the examination of bronchoalveolar lavage demonstrated the presence of Pneumocystis carinii. Intravenous cotrimoxazole was administered but the patient's condition did not improve. As secondary leukopenia appeared, the treatment was changed to pentamidine isethionate 4 mg/kg/d i.v. On day 5 of this new therapy, the patient experienced abdominal pain, and both blood and urine amylase concentrations raised to 330 U/L and 3960 U/L, respectively. The patient died 48 hours later, and signs of acute pancreatitis were observed in necropsy.. With reference to a classical method for estimating the probability of adverse drug reactions, a probable relationship between pentamidine therapy and acute pancreatitis was found in this patient. Furthermore, no alternative causes of pancreatitis were present.. It is likely that pentamidine administration in our patient resulted in an acute episode of pancreatitis. Serum and urine amylase concentrations should be monitored in patients receiving this drug.

Topics: Acute Disease; Adult; AIDS-Related Opportunistic Infections; Humans; Male; Methylprednisolone; Pancreatitis; Pentamidine; Pneumonia, Pneumocystis; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acquired Immunodeficiency Syndrome; Adult; Amylases; Female; Humans; Pancreatitis; Pneumonia, Pneumocystis; Trimethoprim, Sulfamethoxazole Drug Combination

We have reported a case of sulfonamide-induced acute pancreatitis. A review of the literature showed only eight previously reported cases. Adverse reactions to sulfonamides are well known, but acute pancreatitis is a very serious complication. If evidence of pancreatic involvement occurs during sulfonamide therapy, the medication should be discontinued immediately and, if necessary, be replaced by an alternative. Other causes of pancreatitis must be excluded.

Topics: Acute Disease; Alanine Transaminase; Alkaline Phosphatase; Aspartate Aminotransferases; Brain Abscess; Endoscopy, Digestive System; Humans; Male; Middle Aged; Nocardia Infections; Pancreatitis; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination

We report the case of a 26-yr-old patient with fulminant liver failure and acute hemorrhagic pancreatitis secondary to the use of trimethoprim-sulfamethoxazole (Bactrim DS). Our patient presented with skin rash and decreased C3 and C4 levels, which we believed was due to a hypersensitivity reaction secondary to the sulfonamide component (sulfamethoxazole). To our knowledge, this is the first case reported in which sulfamethoxazole-trimethoprim has been implicated as a cause of fulminant liver failure and acute hemorrhagic pancreatitis simultaneously, and emphasizes the need of discontinuing this medication as soon as there is evidence of liver and pancreatic dysfunction.

Topics: Adult; Chemical and Drug Induced Liver Injury; Complement C3; Complement C4; Drug Hypersensitivity; Erythema; Hemorrhage; Humans; Male; Pancreatitis; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Adult; Amylases; Brain Abscess; Drug Combinations; Humans; Male; Nocardia asteroides; Nocardia Infections; Pancreatitis; Recurrence; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

The penetrance of mezlocillin, metronidazole and trimethoprim-sulfamethoxazole into the pancreatic juice of humans was measured in ten patients convalescing from acute pancreatitis at the time of endoscopic retrograde cholangiopancreatography. Therapeutic levels were obtained in the serum for all three antimicrobial agents; simultaneously aspirated nonbile stained pancreatic juice contained therapeutic levels of metronidazole and trimethoprim-sulfamethoxazole. Mezlocillin was not present in a therapeutic level in any patient with nonbile stained pancreatic fluid.

Topics: Acute Disease; Cholangiopancreatography, Endoscopic Retrograde; Chromatography, High Pressure Liquid; Drug Combinations; Drug Evaluation; Humans; Metronidazole; Mezlocillin; Pancreatic Diseases; Pancreatic Ducts; Pancreatic Juice; Pancreatic Pseudocyst; Pancreatitis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination