TY - JOUR
T1 - Aseptic meningitis, hemolytic anemia, hepatitis, and orthostatic hypotension in a patient treated with trimethoprim-sulfamethoxazole
AU - Chisholm-Burns, Marie A.
AU - Patanwala, Asad E.
AU - Spivey, Christina A.
PY - 2010/1/15
Y1 - 2010/1/15
N2 - 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.
AB - 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.
KW - Anemia
KW - Hepatitis
KW - Hypotension
KW - Meningitis
KW - Sulfamethoxazole
KW - Sulfonamides
KW - Toxicity
KW - Trimethoprim
KW - Urinary antiinfectives
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U2 - 10.2146/ajhp080558
DO - 10.2146/ajhp080558
M3 - Article
C2 - 20065266
AN - SCOPUS:75149166699
SN - 1079-2082
VL - 67
SP - 123
EP - 127
JO - American Journal of Health-System Pharmacy
JF - American Journal of Health-System Pharmacy
IS - 2
ER -