Bilateral anterior uveitis and retinal haemorrhages after administration of trimethoprim

Abstract

ABSTRACT. In this case report we present a female patient with recurrent urinary infection treated with trimethoprim/sulfamethoxazole, trimethoprim alone and ciprofloxacin. She developed adverse systemic symptoms and bilateral anterior uveitis following administration of the former two drugs, and in addition retinal haemorrhages after the use of trimethoprim. Uveitis and retinal haemorrhages are rare side effects of trimethoprim/sulfamethoxazole. To our best knowledge they have not been described as a side effect of trimethoprim alone. and in November they had cleared completely.The patient had several exposures of TMP/SMX and trimethoprim alone resulting in uveitis, but not when treated with ciprofloxacin.

Drug-induced uveitis

“…Her work-up was unremarkable, and her inflammation promptly resolved with topical therapy and drug discontinuation, only to recur 45 min following rechallenge with 200 mg of trimethoprim [55]. On two separate occasions, a 38-year-old woman developed flu-like symptoms as well as bilateral non-granulomatous anterior uveitis within days of starting trimethoprim-sulfamethoxazole [56]. She subsequently developed bilateral non-granulomatous anterior uveitis within a day of starting trimethoprim alone.…”

“…She subsequently developed bilateral non-granulomatous anterior uveitis within a day of starting trimethoprim alone. All episodes resolved promptly with topical corticosteroid therapy [56]. …”

Trimethoprim‐associated uveitis and retinal vasculitis

“…The right eye shows vessel staining temporal to the optic disc and vascular sheathing of the inferotemporal arcade reported additional findings of retinal dot haemorrhages, which may have represented undiagnosed retinal vasculitis. 2 These prior cases were observed among females aged between 18 and 41. In contrast, we report a case observed in an older female aged 74.…”

“…Trimethoprim administered systemically is detectable in aqueous and vitreous humour. 2 Medication-induced uveitis can occur with topical or systemic agents. Sulfonamides are a well-documented cause.…”

“…To the best of our knowledge, uveitis associated with trimethoprim monotherapy has been reported in four cases. [2][3][4][5] All cases documented bilateral acute anterior uveitis with rapid and complete recovery. Our case was in keeping with this pattern.…”