Aseptic meningitis, hemolytic anemia, hepatitis, and orthostatic hypotension in a patient treated with trimethoprim-sulfamethoxazole

Marie A. Chisholm-Burns, Asad E. Patanwala, Christina A. Spivey

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Purpose. The case of a patient who developed aseptic meningitis, hemolytic anemia, hepatitis, and orthostatic hypotension simultaneously during treatment with trimethoprim-sulfamethoxazole is described. Background. A healthy 37-year-old African-American man was receiving treatment with trimethoprim-sulfamethoxazole double strength. This was the patient's first experience with trimethoprim-sulfamethoxazole, and he was not taking any other medications during the treatment period. He had been taking trimethoprim- sulfamethoxazole for approximately eight days when he revisited his family physician, complaining of headaches, dizziness, difficulty with speech, weakness, and itching on the trunk of his body and legs, where a maculopapular rash was noted. Orthostatic hypotension was also noted at that visit, with a standing blood pressure measurement of 95/80 mm Hg. Based on these findings and since the patient had no signs of infection, his physician instructed him to discontinue the drug. The patient was admitted to the emergency department of a local hospital within two days due to ongoing headache, elevated temperature, and nuchal rigidity, symptoms suggestive of meningitis. Because of the presence of hemolysis, the patient underwent testing for glucose-6-phosphate dehydrogenase (G6PD) deficiency, for which he tested positive. The patient was discharged five days after admission and referred to a hematology clinic for follow-up. The patient has since returned to his routines of daily living and has reported no fatigue or other lingering adverse symptoms. Conclusion. A 37-year-old African-American man with G6PD deficiency developed hemolytic anemia, hepatitis, orthostatic hypotension, and aseptic meningitis simultaneously after using trimethoprim-sulfamethoxazole.

Original languageEnglish (US)
Pages (from-to)123-127
Number of pages5
JournalAmerican Journal of Health-System Pharmacy
Issue number2
StatePublished - Jan 15 2010


  • Anemia
  • Hepatitis
  • Hypotension
  • Meningitis
  • Sulfamethoxazole
  • Sulfonamides
  • Toxicity
  • Trimethoprim
  • Urinary antiinfectives

ASJC Scopus subject areas

  • Pharmacology
  • Health Policy


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