Methemoglobinemia Induced by Trimethoprim-Sulfamethoxazole in a Patient with Systemic Lupus Erythematosus

Kawasumi, Hidenaga; Tanaka, Eiichi; Hoshi, Daisuke; Kawaguchi, Yasushi; Yamanaka, Hisashi

doi:10.2169/internalmedicine.52.0247

Cited by 12 publications

(13 citation statements)

References 16 publications

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“…In our patient, because of his immunocompromised status, SMX/TMP was indicated for prophylaxis of a common opportunistic infection, Pneumocysitis jiroveci , which is a known cause of morbidity and mortality in patients with malignancies. When given for an active infection, SMX/TMP is a known cause of methemoglobinemia, as described in many previous case reports [ 1 – 7 , 12 ]. All of these case reports were of adult patients, and all patients were receiving SMX/TMP at treatment doses, with one exception.…”

Section: Discussionmentioning

confidence: 93%

“…Methemoglobinemia can be either congenital or acquired [ 12 ]. Acquired forms of the disease are far more common and are usually induced by medications such as SMX/TMP, dapsone, lidocaine, benzocaine, acetaminophen, and nitroprusside [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…All of these case reports were of adult patients, and all patients were receiving SMX/TMP at treatment doses, with one exception. Kawasumi et al reported the case of an adult systemic lupus erythematosus patient who received the appropriate adult prophylactic dosing for opportunistic infections (400/80 mg), but received only one dose before developing methemoglobinemia [ 12 ]. To our knowledge, our case is the first report of the development of methemoglobinemia in a pediatric patient receiving prophylactic dosing given three times weekly, which represents a markedly reduced dose when compared with treatment for active infection (24 mg/day given three times weekly vs. 75–100 mg in daily divided doses, respectively).…”

Section: Discussionmentioning

confidence: 99%

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Methemoglobinemia in a Pediatric Oncology Patient Receiving Sulfamethoxazole/Trimethoprim Prophylaxis

Carroll

2016

Am J Case Rep

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Patient: Male, 6-monthFinal Diagnosis: MethemoglobinemiaSymptoms: —Medication: Sulfamethoxazole/trimethoprimClinical Procedure: Methylene blue administrationSpecialty: Pediatrics and NeonatologyObjective:Unusual or unexpected effect of treatmentBackground:Methemoglobinemia due to the administration of sulfamethoxazole/trimethoprim has been documented in a series of case reports. However, all of these reports are on adult patients, and all patients received at least daily administration of sulfamethoxazole/trimethoprim for the treatment of active or suspected infection.Case Report:Herein we report the development of methemoglobinemia in a pediatric patient receiving sulfamethoxazole/trimethoprim three times weekly for the prophylaxis of opportunistic infections.Conclusions:The clinician should always consider sulfamethoxazole/trimethoprim, even when administered for opportunistic infection prophylaxis at reduced doses and intervals, as a possible cause of methemoglobinemia.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Methemoglobinemia in a Pediatric Oncology Patient Receiving Sulfamethoxazole/Trimethoprim Prophylaxis

Carroll

2016

Am J Case Rep

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“…Kawasumi ve arkadaşları 2013 yılında 43 yaşındaki SLE'li bir kadında trimethoprim-sulfamethoxazole ile pneumocystis pneumonia profilaksisi sırasında tedavinin 9. günün-de methemoglobinemi oluştuğunu rapor etmişlerdir (8). Methemoglobineminin tanısı için öncelikle hekimlerin oldukça dikkatli bir gözlem yapmaları çok önemlidir.…”

Section: Discussionunclassified

Üç günlük yenidoğanda methemoglobinemi; olgu sunumu

Korkmaz¹,

Korkut²,

Baştuğ³

et al. 2017

Bakirkoy

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Methemoglobinemia in a 3 days old new born: case reportLocal anesthesia with prilocaine is a frequent practice in our country to prevent the pain during circumcision. Prilocaine, in turn, has been demonstrated to potentially cause methemoglobinemia in young babies and newborns. Herein we have presented a case of methemoglobinemia in a three-days-old male newborn hospitalized upon the detection of cyanosis and hypoactivity at the physical examination during follow up period immediately after circumcision under anesthesia with prilocaine. At presentation, the patient had no other sign than those of cyanosis and hypoactivity. Blood methemoglobin level was found to be %32.4, and complete recovery was achieved with treatment. Fetal hemoglobin is more susceptible to ferric state, and the systems to help the prevention of methemoglobinemia are insufficient in early periods of life. For these reasons, it has been discussed here that in young children other anesthetic agents than prilocaine should be used. In this case the search related with this subject has also been discussed in the light of literature knowledge and experience.

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“…[11][12][13] MeHb caused by TMP-SMX is relatively rare, with only a handful of cases reported in the literature. 15,16 Diagnosis is made on the basis of clinical features such as cyanosis, together with arterial blood gases and methaemoglobin levels. Pulse oximetry is inaccurate for measuring oxygen saturation in the presence of MeHb, and this issue becomes apparent when the pulse oximetry readings differ markedly from the arterial blood gases causing a 'saturation gap'.…”

Section: Discussionmentioning

confidence: 99%

Methaemoglobinaemia associated with trimethoprim/sulfamethoxazole treatment on a background of leflunomide‐induced pneumonitis

Klusak

Truloff

2015

Pharmacy Practice and Res

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Background Immunomodulating drugs such as leflunomide are known to be associated with immunosuppression and infection. Off‐label use of such agents may place patients at increased risk of potentially unforeseen adverse effects not commonly observed in clinical trials. Aim To describe a case of leflunomide‐induced pneumonitis, which may have contributed to the development of Pneumocystis jirovecii pneumonia (PJP). Treatment of the infection with trimethoprim/sulfamethoxazole (TMP‐SMX) in this case was associated with the development of methaemoglobinaemia, a relatively rare adverse effect associated with this agent. Clinical details A 72‐year‐old female presented with a 2‐week history of progressive dyspnoea and orthopnoea with a background of newly diagnosed, biopsy proven, membranous glomerulonephropathy. She had recently started leflunomide and prednisolone for resistant proteinuria. Soon after admission, her respiratory status deteriorated with tachypnoea (30–40/min) and hypoxia requiring large amounts of supplemental oxygen (oxygen saturation (SaO2) 95%, partial pressure of oxygen (PO2) 68 mmHg with 10 L/min of oxygen). A chest X‐ray and computed tomography revealed diffuse bilateral ground glass opacities with multimodal consolidation. Sputum polymerase chain reaction testing was positive for P. jirovecii, and a diagnosis of PJP was made. Subsequent treatment with primaquine and TMP‐SMX was linked to the development of drug‐induced methaemoglobinaemia (MeHb). Outcome The antimicrobial regime was changed to intravenous (IV) pentamidine as an alternative treatment for P. jirovecii pneumonia. Despite this, there was further deterioration associated with a suspected secondary bacterial pneumonia. Additional IV antibiotics were added, including piperacillin/tazobactam and vancomycin. Following failure to respond to this treatment, active interventions were withdrawn after family discussions. Palliative care measures were implemented and she died 4 days later. Conclusion Pharmacists should be aware of the potential for serious, rare adverse effects associated with immunomodulating drugs. Patients must be informed of the risks associated with treatment and the evidence for benefit when these drugs are prescribed for off‐label use. PJP pneumonia prophylaxis should be considered for patients commencing high dose, chronic corticosteroid therapy. Methaemoglobin should be measured for patients who become significantly hypoxic after treatment with trimethoprim/sulfamethoxazole.

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Methemoglobinemia Induced by Trimethoprim-Sulfamethoxazole in a Patient with Systemic Lupus Erythematosus

Cited by 12 publications

References 16 publications

Methemoglobinemia in a Pediatric Oncology Patient Receiving Sulfamethoxazole/Trimethoprim Prophylaxis

Methemoglobinemia in a Pediatric Oncology Patient Receiving Sulfamethoxazole/Trimethoprim Prophylaxis

Üç günlük yenidoğanda methemoglobinemi; olgu sunumu

Methaemoglobinaemia associated with trimethoprim/sulfamethoxazole treatment on a background of leflunomide‐induced pneumonitis

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