trimethoprim--sulfamethoxazole-drug-combination and Urticaria

The purpose of this study was to report recurrent optic disc and retinal vasculitis in a patient with drug-induced urticarial vasculitis. Complete ophthalmological examination including fluorescein angiography and visual field examination were done. A 53-year-old woman with recurrent painful urticarial skin lesions following trimethoprim sulfamethoxazole usage had the clinical and histopathological diagnosis of urticarial vasculitis. Two years after cutaneous manifestations, she began to notice visual disturbances in both eyes that recurred at 1-year intervals. Her ophthalmological findings were consistent with recurrent vasculitis of the optic nerve and retina. Treatment with high-dose corticosteroids and hydroxychloroquine resulted in the resolution of cutaneous and ocular manifestations. This patient demonstrates that recurrent occlusive vasculitis of the optic nerve and retina can occur in this rare disease. These patients should be examined periodically by ophthalmologists.

Topics: Anti-Infective Agents; Dermatologic Agents; Drug Industry; Drug Therapy, Combination; Female; Glucocorticoids; Humans; Hydroxychloroquine; Methylprednisolone; Middle Aged; Optic Disk; Pulse Therapy, Drug; Recurrence; Retinal Vasculitis; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urticaria; Vasculitis, Leukocytoclastic, Cutaneous

Urticarian vasculitis (UV) is an anatomoclinical disorder characterized by the association of urticarian papules lasting for more than 24 hours with histological cutaneous vasculitis. Several etiologies are associated with the disease. We report the case of a 30-year-old woman with a-two-month history of urticarial purpuric and necrotic cutaneous lesions of the low limbs. These lesions occurred after oral sulfamethoxazole-trimethoprime ingestion, 2 weeks before the skin eruption. Histological examination revealed a leucocytoclasic vasculitis and direct immunofluorescence showed a perivascular IgG and C3 deposits. Immunological, allergological and radiological investigations were normal. The pharmacological enquiry confirmed the imputability of sulfamethoxazole-trimethoprime in the onset of skin eruption. Mild cutaneous improvement was observed after 3 months of treatment with prednisone 0,5 mg/Kg/day. Drug induced urticaria constitutes a rare etiology of UV. Sulfaminthoxazole-trimethoprime imputability has not been reported before among the drug responsible for UV. Management of patients is difficult and improvement usually occurs after several months because of the resistance of the skin lesions.

Topics: Adult; Anti-Bacterial Agents; Anti-Inflammatory Agents; Complement C3; Drug Eruptions; Female; Fluorescent Antibody Technique, Direct; Humans; Immunoglobulin G; Prednisone; Trimethoprim, Sulfamethoxazole Drug Combination; Urticaria; Vasculitis, Leukocytoclastic, Cutaneous

Topics: Anti-Infective Agents; Diagnosis, Differential; Drug Eruptions; Histamine H1 Antagonists; Humans; Male; Middle Aged; Prostatitis; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urticaria

Topics: Diphenhydramine; Histamine H1 Antagonists; Humans; Trimethoprim, Sulfamethoxazole Drug Combination; Urticaria

Topics: Anti-Infective Agents, Urinary; Diagnosis, Differential; Drug Eruptions; Exanthema; Humans; Kidney Transplantation; Male; Middle Aged; Serum Sickness; Stevens-Johnson Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination; Urticaria

Various types of cutaneous drug eruptions and the incriminating drugs were analyzed in 50 children and adolescents up to 18 years of age (34 or 65% boys, 16 or 32% girls). Thirteen (26%) patients had a maculopapular rash, 11 (22%) a fixed drug eruption (FDE), 10 erythema multiforme (EM), 6 (12%) toxic epidermal necrolysis (TEN), 5 (10%) Stevens-Johnson syndrome (SJS), 3 (6%) urticaria, and 2 (4%) erythroderma. The incubation period for maculopapular rashes, SJS and TEN due to commonly used antibiotics and sulfonamides was short, a few hours to two to three days, reflecting reexposure, and for drugs used sparingly such as antiepileptics and antituberculosis agents, was approximately one week or more, suggesting a first exposure. Antibiotics were responsible for cutaneous eruptions in 27 patients, followed by antiepileptics in 17, analgin in 4, and metronidazole and albendazole in 1 each. Cotrimoxazole, a combination of sulfamethoxazole and trimethoprim, was the most common antibacterial responsible for eruptions (11 patients), followed by penicillin and its semisynthetic derivatives (8 patients), sulfonamide alone (3 patients), and other antibiotics (4 patients). Antiepileptics were the most frequently incriminated drugs in EM, TEN, and SJS. The role of systemic corticosteroids in the management of SJS and TEN is controversial. We administered prednisolone or an equivalent corticosteroid 2 mg/kg/day for 7 to 14 days.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Anti-Bacterial Agents; Anticonvulsants; Antitubercular Agents; Case-Control Studies; Child; Child, Preschool; Dermatitis, Exfoliative; Dipyrone; Drug Eruptions; Erythema Multiforme; Female; Humans; India; Infant; Male; Penicillins; Prednisolone; Prospective Studies; Stevens-Johnson Syndrome; Sulfonamides; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urticaria

We present two patients who experienced life-threatening immediate reactions and one patient who developed generalized urticaria following oral administration of trimethoprim (TMP) and sulfamethoxazole (SMX) combination. Skin prick tests with TMP were positive in the three patients. No patients reacted to skin prick tests with SMX. No significant levels of IgE antibodies to TMP were found by RAST in the serum of the patients. Normal subjects used as controls did not react to any of these tests. Single-blind, placebo-controlled oral challenges were positive with TMP and negative with SMX in all patients. These results suggest that the three patients developed type I hypersensitivity reactions to TMP. In our patients skin prick tests with TMP were useful in TMP hypersensitivity diagnosis.

Topics: Adult; Drug Eruptions; Female; Humans; Respiratory Tract Infections; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urticaria