Trimethoprim-sulfamethoxazole induced circulatory shock in a human immunodeficiency virus uninfected patient: a case report and review

被引:6
作者
Liu, Patricia [1 ]
Ranches, Gregory P. [2 ]
Gold, Jeffrey A. [2 ]
机构
[1] Oregon Hlth & Sci Univ, Dept Internal Med, VA P-3 GP1,Block 4,3181 SW Sam Jackson Pk Rd, Portland, OR 97239 USA
[2] Oregon Hlth & Sci Univ, Div Pulm & Crit Care Med, Portland, OR 97201 USA
关键词
Adverse drug reaction; Shock; HIV; CD4+count; IL-6; Trimethoprim-sulfamethoxazole; PNEUMOCYSTIS-CARINII-PNEUMONIA; ADVERSE-REACTIONS; ASEPTIC-MENINGITIS; INFECTED PATIENTS; SEPTIC-SHOCK; INTERLEUKIN-6; COTRIMOXAZOLE; AIDS; DISEASE;
D O I
10.1186/s40360-018-0269-3
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
BackgroundSevere systemic reactions resembling septic shock have been described following trimethoprim-sulfamethoxazole (TMP-SMX) administration. Nearly all cases described in the literature occurred in HIV-infected patients.Case presentationWe present a 42-year-old woman with a history of systemic lupus erythematosus (SLE) who was admitted to the Intensive Care Unit (ICU) twice with fever and circulatory shock after taking a dose of TMP-SMX 800-160mg. She had no respiratory distress, urticarial rash or eosinophilia on presentation. Infectious workup during both admissions was negative and treatment with antibiotics, steroids and vasopressors was de-escalated with clinical improvement. She was found to be HIV negative, however, labs revealed a low CD4+ count.ConclusionsTMP-SMX can rarely result in a severe, non-anaphylactic circulatory shock; if initially unrecognized, patients may undergo repeat drug exposure with an associated high morbidity risk. While more commonly reported in HIV individuals, this case demonstrates that TMP-SMX related circulatory shock can occur in a HIV negative patient.
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页数:5
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