<b><i>Background:</i></b> Trimethoprim-sulfamethoxazole (TMP/SMX) causes hyperkalemia, and hyponatremia caused by TMP/SMX is a challenge for clinicians. We described the clinical features of hyponatremia induced by TMP/SMX after collecting cases. <b><i>Summary:</i></b> The median age of the 24 patients (10 males and 14 females) was 67 years (range: 28–90 years). Hyponatremia induced by TMP/SMX manifested as nausea (41.7%) and vomiting (29.2%) or asymptomatic hyponatremia (20.8%). The median duration of hyponatremia was 5 days (range: 3–10 days). The median serum sodium concentration was 118 mmol/L (range: 101–128.1 mmol/L). The serum sodium levels gradually returned to the normal range at 4 days (median; range: 2–14 days) after withdrawing TMP/SMX. <b><i>Key Messages:</i></b> TMP/SMX-induced hyponatremia is a rare and serious adverse reaction. Clinicians should be aware of electrolyte disturbances caused by TMP/SMX and should always consider electrolyte monitoring.

Background. Acute generalized exanthematous pustulosis (AGEP) is a rare and serious adverse reaction of terbinafine. Understanding AGEP and terbinafine is primarily based on case reports. The purpose is to explore the clinical characteristics of terbinafine-induced AGEP, and to provide reference for clinical diagnosis and treatment. Methods. Case reports and original studies of terbinafine-induced AGEP were retrieved by searching Chinese and English databases from January, 1991, to May 31, 2022. Results. The median age of the 32 patients (17 males and 15 females) was 55 years (range: 6–84). The median time to onset of AGEP is 8 days (range: 1–77) and is usually accompanied by fever (>38°C) and elevated neutrophil levels (>8000/mm3). Four patients (12.5%) had oral mucosal involvement, and 10 patients (31.3%) developed postpustular desquamation. The lesions were mainly distributed in the trunk (43.8%), the whole body (34.4%), and the extremities (53.1%). Skin biopsy revealed subcorneal pustules (65.6%), intraepidermal cavernous pustules (43.8%), necrotic keratinocytes (15.6%), spongy hyperplasia (25.0%), neutrophil exocytosis (34.4%), and papillary dermal edema (40.6%). AGEP resolved completely in all patients at a median time of 12 days (range: 2–90) after discontinuation of terbinafine and symptomatic therapy. Conclusion. Clinicians should be aware that terbinafine-induced AGEP is a rare cutaneous adverse reaction. AGEP usually occurs within 2 weeks after administration and has a good prognosis after discontinuation.

Haemophagocytic lymphohistiocytosis (HLH), also known as haemophagocytic syndrome (HPS), is an immune dysregulation disease.HLH can be familial and occur most often in infants but can occur at any age. HLH is characterized by an unremitting activation of CD8+ T cells and macrophages. 1 Clinical features can include fever and rash, splenomegaly, hepatitis, cytopenia, elevated triglyceride levels or low fibrinogen levels, hyperferritinaemia, haemophagocytosis, decreased or absent natural killer cell activity and elevated CD25 blood levels. 2 The usual causes are infections, malignancy or rheumatological conditions, while drugs cause a small number of cases of HLH. 3 If untreated, it causes organ damage, particularly in the liver, bone marrow and, presumably, the central nervous system (CNS); the median survival without treatment is estimated to be less than 2 months. 4 Lamotrigine was marketed in 1994 and was approved for the treatment of focal (partial) seizures, primary generalized tonicclonic seizures and generalized seizures of Lennox-Gastaut syndrome in both children and adults and for maintenance treatment in adults with bipolar disorder. 5 Lamotrigine is available as an oral tablet, an orally disintegrating tablet (ODT), a chewable tablet (CD) and

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