Acute Parotitis Induced by Trimethoprim/Sulfamethoxazole

Abstract

Adverse drug reactions to the sulfonamide antibiotics are uncommon. When they do occur, they usually manifest as a rash or urticaria. Our review of the recent literature found that while sialadenitis is listed as a possible side eff ect of sulfonamide use, no actual case has ever been reported until now. We describe a case of acute bilateral parotitis that arose as a side eff ect of sulfonamide antibiotic treatment. We also examine the relevance of such pathology to the proposed mechanisms of sialadenitis, and we briefl y discuss sulfonamide-induced pancreatitis. Lastly, we review the controversy over the possibility that some adverse drug reactions may be caused by crossreactivity among diff erent classes of sulfonamides.

Clinical Manifestations and Genetic Influences in Sulfonamide-Induced Hypersensitivity

“…52 Based on this case, parotitis is considered delayed-hypersensitivity because the reaction appears after several doses have been taken by the patient. 51 Based on Wu et al, an increased level of IgE in parotitis patients indicates type I hypersensitivity may be involved. 53 The exact mechanism by which TMP/SMX induces parotitis is yet unknown.…”

“…Thus, it is known that the patient's parotitis was caused by hypersensitivity and caused by TMP/SMX. 51 Alternative therapy is given to the patient, such as an injection of methylprednisolone and increased fluid intake. 51 It is necessary to take preventive measures by limiting drugs known to cause SJS/TEN.…”

“… 50 Commonly referred to include anticholinergics, antihistamines, and antipsychotics. 51 Based on Patel et al, this case of parotitis induced with TMP/SMX drugs was the first recorded in the literature. In this case, a 44-year-old man had bilateral parotid swelling with a tenderness that appeared seven days after treatment with TMP/SMX.…”

“…There was no viral or bacterial cause, and when the drug was discontinued, the patient’s symptoms improved. 51 Until 2016, Baer et al identified 56 cases were salivary gland swelling with eosinophil-rich mucus. 52 Based on this case, parotitis is considered delayed-hypersensitivity because the reaction appears after several doses have been taken by the patient.…”

“…Thus, it is known that the patient’s parotitis was caused by hypersensitivity and caused by TMP/SMX. 51 …”