trimethoprim--sulfamethoxazole-drug-combination and Sunburn

Trimethoprim-sulfamethoxazole (TMP-SMX) hypersensitivity reaction, ranging from circulatory shock to aseptic meningitis and respiratory failure, is a potentially life-threatening condition with dermatologic relevance.. To describe the mucocutaneous findings and clinical features of TMP-SMX hypersensitivity reaction.. This was a retrospective case series study of 7 patients who developed a characteristic rash, hemodynamic changes, and end-organ dysfunction after treatment with TMP-SMX at a large university hospital system during January 2013 to March 2022.. Treatment with TMP-SMX within 2 weeks of the reaction.. Descriptions of the condition, including the demographic information of the affected population, the reaction timeline, and mucocutaneous and clinical features.. The cohort comprised 7 patients (median [range] age, 20 [15-66] years; 4 female and 3 male). The most common mucocutaneous findings were generalized sunburn-like erythema without scale, conjunctivitis, and mild facial and acral edema. Three patients had previous exposure to TMP-SMX and developed symptoms in 1 day or less, while those without prior exposure presented from 4 to 11 days after drug initiation. Among the 7 patients, 6 had fever, 7 had hypotension, and 7 had tachycardia. All patients had lymphopenia and evidence of end-organ dysfunction with either kidney or liver involvement. Median (range) time to resolution was 72 (48-96) hours.. This retrospective case series indicates that SCoRCH (sudden conjunctivitis, lymphopenia, and rash combined with hemodynamic changes) should be considered in the differential diagnosis of patients presenting with acute generalized sunburn-like erythema, conjunctivitis, systemic symptoms, and hemodynamic changes in the setting of recent TMP-SMX use.

Topics: Adult; Exanthema; Female; Humans; Hypersensitivity; Lymphopenia; Male; Multiple Organ Failure; Retrospective Studies; Sunburn; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

Two patients are described in whom sunburn and electron beam radiodermatitis, respectively, were critical determinants in localizing the initial presentation of drug eruptions. In the first instance, a severe sunburn of the back and thighs was followed 7 months later by the appearance of a toxic epidermal necrolysis drug reaction to trimethoprim-sulfamethoxazole in the exact sites of the previous bullous sunburn reaction. In the second patient, a radiodermatitis of the left upper arm due to electron beam therapy for metastatic breast cancer was followed 7 weeks later by a codeine drug reaction confined to the area of the radiodermatitis. In both instances, oral rechallenge with the offending drug reproduced the eruption.

Topics: Adult; Breast Neoplasms; Codeine; Drug Combinations; Drug Eruptions; Female; Humans; Middle Aged; Radiodermatitis; Skin; Sulfamethoxazole; Sunburn; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination