trimethoprim--sulfamethoxazole-drug-combination and Stomach-Neoplasms

We report a death case of a man in his sixties with pneumocystis pneumonia during chemotherapy for gastric cancer. He was diagnosed with cStage IIIB (T4a, N2, H0, P0, M0). Because of bulky N2, systemic chemotherapy of S-1 and CDDP was performed from April 2009. But no reductions were noted after 2 courses. We next treated this patient with S-1 and CPT-11. He had also received corticosteroid treatment for nausea. Because of high fever and choke, he came to our hospital at day 12 in 3 courses, and a severe respiratory failure occurred. CT of the chest showed diffuse ground-glass bilateral opacities, and we immediately started a treatment with trimethoprim-sulfamethozazole and corticosteroid for the possibility of pneumocystis pneumonia. We finally deduced pneumocystis pneumonia from markedly elevated serum beta-D-glucan and PCR positive after hospitalization. In spite of early treatments, he died of bacterial pneumonia and gastric cancer. We should be careful of pneumocystis pneumonia during chemotherapy and corticosteroid treatment.

Topics: Antineoplastic Agents, Phytogenic; Camptothecin; Dexamethasone; Drug Combinations; Fatal Outcome; Glucocorticoids; Humans; Irinotecan; Male; Middle Aged; Oxonic Acid; Pneumonia, Pneumocystis; Stomach Neoplasms; Tegafur; Trimethoprim, Sulfamethoxazole Drug Combination

We report the case of a 57 year old male with Whipple's disease. The patient was asymptomatic and an unexplained peripheral leucocytosis was found in a routine examination. It persisted as the only abnormality for one year and then he developed articular symptoms, diarrhoea and weight loss. The diagnosis was confirmed by duodenal biopsy five years later. The leucocyte count ranged between 14,000 and 22,000 leuc/mm3. Response to cotrimoxazole was favourable with disappearance of all signs and symptoms, including leucocytosis. In the last endoscopic control, eight years after initial manifestations, an intramucosal gastric adenocarcinoma was diagnosed.

Topics: Adenocarcinoma; Anti-Infective Agents; Biopsy; Duodenum; Follow-Up Studies; Gastrectomy; Humans; Leukocytosis; Male; Middle Aged; Stomach; Stomach Neoplasms; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Whipple Disease

A case of pulmonary nocardiosis with empyema in a 55-year-old man with macroglobulinemic lymphoma is presented. Treatment with imipenem followed by oral trimethoprim-sulfamethoxazole (TMP-SMX) resolved his symptoms and cleared the roentgenographic abnormalities. This case illustrates the clinical potential of imipenem against Nocardia.

Topics: Drug Therapy, Combination; Empyema; Humans; Imipenem; Lung Diseases; Lung Neoplasms; Lymphoma; Male; Microbial Sensitivity Tests; Middle Aged; Nocardia asteroides; Nocardia Infections; Opportunistic Infections; Stomach Neoplasms; Trimethoprim, Sulfamethoxazole Drug Combination; Waldenstrom Macroglobulinemia