trimethoprim--sulfamethoxazole-drug-combination and Pulmonary-Edema

Torsades de pointes (TdP) is a rapid, polymorphic and usually self-terminating ventricular tachycardia associated with the long QT syndrome. Many drugs may cause prolongation of QT interval and be the trigger for TdP occurrence. We present the case of 52-year-old male who was treated with clarithromycin due to bilateral atypical pneumonia. However, on the fourth day of hospitalization he deteriorated, developed pulmonary edema and short cardiac arrest. After successful resuscitation, unfortunately amiodarone and co-trimoxazole were given causing the arrhythmic storm which required many defibrillations. The case highlights the importance of careful QT measurement, appropriate TdP treatment and difficulties resulting from the patient's disagreement for invasive treatment. We think, that knowledge of drug-induced long QT syndrome and its consequences should be widely spread not only in cardiologists, but also in others doctors.

Topics: Amiodarone; Anti-Arrhythmia Agents; Clarithromycin; Drug Therapy, Combination; Electrocardiography; Heart Arrest; Humans; Long QT Syndrome; Male; Middle Aged; Pneumonia; Pulmonary Edema; Torsades de Pointes; Trimethoprim, Sulfamethoxazole Drug Combination

A patient with acquired immunodeficiency syndrome (AIDS) developed rash, fever, neutropenia, and elevated liver function tests during an initial course of trimethoprim-sulfamethoxazole (TMP-SMX) therapy. Upon reexposure to the drug, the patient experienced a severe anaphylactoid reaction associated with pulmonary edema and rhabdomyolysis. Reactions associated with TMP-SMX rechallenge in this patient population have been previously reported but have not been associated with this degree of severity. TMP-SMX therapy should be instituted with extreme caution in patients with AIDS who have demonstrated a prior hypersensitivity reaction to the drug.

Topics: Acquired Immunodeficiency Syndrome; Adult; Dermatitis, Exfoliative; Drug Combinations; Drug Hypersensitivity; Fever; Humans; Hypersensitivity, Delayed; Male; Pneumonia, Pneumocystis; Pulmonary Edema; Rhabdomyolysis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination