trimethoprim--sulfamethoxazole-drug-combination and Thrombosis

Antiphospholipid antibody syndrome (APS) results from autoantibodies to cell surface phospholipids or phospholipid-binding proteins resulting in clotting anomalies and can have devastating sequelae, including stroke, deep venous thrombosis, pulmonary embolism, and recurrent spontaneous abortions. However, cutaneous manifestations are the first sign of APS in up to 41% of patients. We present a case report of APS that developed several days after taking trimethoprim/sulfamethoxazole. The clinical and pathological features of this unique presentation, differential diagnoses, and treatments are discussed.

Topics: Anti-Infective Agents; Antiphospholipid Syndrome; Autoantibodies; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Middle Aged; Thrombosis; Trimethoprim, Sulfamethoxazole Drug Combination

A 73 year old male was hospitalised with fever of unknown origin and episodes with septic shock. During the in-hospital stay the clinical situation deteriorated rapidly, and E. coli was isolated from bloodcultures. All routine investigations revealed no specific abnormalities except for the electrocardiogram, which showed an old anterior-apical infarction although no history of cardiac disease was present. A CT-scan of the thorax and a scintigraphy using labelled autologous leucocytes made the diagnosis of a myocardial abscess, located in an apical aneurysm, probable. No other site of infection could be found and so it was decided to perform an aneurysmectomy with abscess evacuation in combination with extensive antibiotic treatment. After two years the patient is doing well. Only one case of survival has been reported before, also after surgical intervention. This underlines the importance of early diagnosis and aggressive therapy especially with regard to the reported high incidence of cardiac rupture.

Topics: Abscess; Aged; Combined Modality Therapy; Drug Combinations; Endocarditis, Bacterial; Escherichia coli Infections; Heart Aneurysm; Humans; Male; Myocardial Infarction; Sulfamethoxazole; Thrombosis; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination