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

Liu, Patricia; Ranches, Gregory; Gold, Jeffrey A.

doi:10.1186/s40360-018-0269-3

Cited by 6 publications

(14 citation statements)

References 19 publications

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“…Histopathologic findings for this entity have yet to be well described but have been found to lack the main histologic features of AGEP. 25 In our case, the cutaneous findings and histopathologic evaluation were both consistent with AGEP, as was the EuroSCAR AGEP validation score.…”

Section: Discussionsupporting

confidence: 82%

“…3 There have also been reports of circulatory shock after administration of trimethoprimsulfamethoxazole, most commonly associated with human immunodeficiency virus. 25 Although these patients may have hypotension, hypoxemia, and renal and liver involvement, the classical cutaneous findings include conjunctivitis, maculopapular rash, and "sunburn-like" generalized erythema without pustules. 25 In patients who present with generalized erythema and associated hypotension after taking trimethoprim-sulfamethoxazole, a biopsy should be considered to distinguish early AGEP from trimethoprim-sulfamethoxazole-induced circulatory shock.…”

Section: Discussionmentioning

confidence: 99%

“…While pustular psoriasis shares similar clinical features with AGEP, the absence of psoriasis history and the timing of the eruption following ingestion of trimethoprim‐sulfamethoxazole supported AGEP 3 . There have also been reports of circulatory shock after administration of trimethoprim‐sulfamethoxazole, most commonly associated with human immunodeficiency virus 25 . Although these patients may have hypotension, hypoxemia, and renal and liver involvement, the classical cutaneous findings include conjunctivitis, maculopapular rash, and “sunburn‐like” generalized erythema without pustules 25 .…”

Section: Discussionmentioning

confidence: 99%

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A severe presentation of acute generalized exanthematous pustulosis with non‐infectious circulatory shock in an adolescent

O'Brian

Kolitz

Jeong

et al. 2021

Pediatric Dermatology

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Acute generalized exanthematous pustulosis (AGEP) is a rapidly evolving adverse drug reaction with a characteristic presentation of diffuse, non-follicular, pinpoint pustules on a background of erythematous plaques, typically located in intertriginous folds. 1 AGEP is uncommon in the pediatric population and is more likely to be associated with atypical cutaneous features. 2 Drugs are the most common trigger, including penicillins, macrolides, sulfonamides, antifungals, diltiazem, hydroxychloroquine, antiinflammatory medications, and anti-epileptics. 3 In the pediatric population, it is suggested that viral infections may have a greater association with AGEP. 2,4 The traditional clinical course of AGEP in pediatric patients is an acute presentation of the classic eruption with associated high-grade fever and elevated neutrophil counts. 4 Although the clinical picture is concerning, AGEP is typically self-limited, with rapid recovery following cessation of the causative agent and an overall favorable prognosis. 1 Systemic involvement of AGEP with reports of hemodynamic

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A severe presentation of acute generalized exanthematous pustulosis with non‐infectious circulatory shock in an adolescent

O'Brian

Kolitz

Jeong

et al. 2021

Pediatric Dermatology

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“…

ypersensitivity reactions (HSRs) with hemodynamic changes have been described after administration of trimethoprim-sulfamethoxazole (TMP-SMX). 1 Various names exist for this reaction, including TMP-SMX induced circulatory shock, and atypical, unusual, anaphylactic-like, or severe shock-like reaction to TMP-SMX. 1,2 This systemic reaction was initially described in patients with HIV.

…”

mentioning

confidence: 99%

Sudden Conjunctivitis, Lymphopenia, and Rash Combined With Hemodynamic Changes (SCoRCH) After Trimethoprim-Sulfamethoxazole Use

et al. 2023

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ImportanceTrimethoprim-sulfamethoxazole (TMP-SMX) hypersensitivity reaction, ranging from circulatory shock to aseptic meningitis and respiratory failure, is a potentially life-threatening condition with dermatologic relevance.ObjectiveTo describe the mucocutaneous findings and clinical features of TMP-SMX hypersensitivity reaction.Design, Setting, and ParticipantsThis was a retrospective case series study of 7 patients who developed a characteristic rash, hemodynamic changes, and end-organ dysfunction after treatment with TMP-SMX at a large university hospital system during January 2013 to March 2022.ExposuresTreatment with TMP-SMX within 2 weeks of the reaction.Main Outcome and MeasuresDescriptions of the condition, including the demographic information of the affected population, the reaction timeline, and mucocutaneous and clinical features.ResultsThe cohort comprised 7 patients (median [range] age, 20 [15-66] years; 4 female and 3 male). The most common mucocutaneous findings were generalized sunburn-like erythema without scale, conjunctivitis, and mild facial and acral edema. Three patients had previous exposure to TMP-SMX and developed symptoms in 1 day or less, while those without prior exposure presented from 4 to 11 days after drug initiation. Among the 7 patients, 6 had fever, 7 had hypotension, and 7 had tachycardia. All patients had lymphopenia and evidence of end-organ dysfunction with either kidney or liver involvement. Median (range) time to resolution was 72 (48-96) hours.Conclusions and RelevanceThis retrospective case series indicates that SCoRCH (sudden conjunctivitis, lymphopenia, and rash combined with hemodynamic changes) should be considered in the differential diagnosis of patients presenting with acute generalized sunburn-like erythema, conjunctivitis, systemic symptoms, and hemodynamic changes in the setting of recent TMP-SMX use.

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“…Multiple heterogeneous factors are responsible for the substantial risk in HIV-infected patients, including polypharmacy, slow acetylator phenotype, glutathione deficiency, a CD4 + T Cell count of <200 cells/mm 3 or >25 cells/mm 3 , latent cytomegalovirus and Epstein-Barr virus infections ( Carr and Cooper, 2000 ). It was reported that the incidence of serious adverse drug reactions (sADRs) of trimethoprim-sulfamethoxazole in HIV-infected persons correlated with the HIV load ( Coopman, 1993 ; Liu et al, 2018 ). Moreover, Rabaud et al studied 592 HIV-infected patients who were first treated with cotrimoxazole during the Delta trial (a randomized, double-blind, controlled trial).…”

Section: Discussionmentioning

confidence: 99%

Case report: Savolitinib induced severe adverse reactions resembling septic shock in an HIV-1–positive patient with advanced non-small cell lung cancer

Cao¹,

Guo²,

Liu³

et al. 2023

Front. Pharmacol.

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Savolitinib, a small-molecule inhibitor of the receptor tyrosine kinase mesenchymal-epithelial transition (MET) factor, was approved for the treatment of non-small cell lung cancer (NSCLC) by the China National Medical Products Administration in June 2021. Its safety for NSCLC treatment has been confirmed in several prospective cohort studies. Herein, we report a rare case of shock, a serious adverse event, after treatment with savolitinib in an HIV-1–positive patient with advanced NSCLC. A 38-year-old man with an 8-year history of HIV-1 positivity was diagnosed with NSCLC 5 years ago; the lung cancer recurred after surgical resection. Despite chemotherapy, immunotherapy, and targeted therapy, tumor progression continued. He received savolitinib because of MET amplification. In the first 2 weeks of savolitinib use, he developed a mild rash on his trunk. In the following month, he was hospitalized for fever and circulatory shock thrice after taking savolitinib 400 mg. He had no urticaria or eosinophilia. During the three hospitalizations, he was negative for pathogens. His condition gradually improved after treatment with antibiotics, steroids, and vasopressors. Attention should be paid to the occurrence of septic shock-like presentations when using savolitinib in HIV-1 patients with NSCLC.

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

Cited by 6 publications

References 19 publications

A severe presentation of acute generalized exanthematous pustulosis with non‐infectious circulatory shock in an adolescent

A severe presentation of acute generalized exanthematous pustulosis with non‐infectious circulatory shock in an adolescent

Sudden Conjunctivitis, Lymphopenia, and Rash Combined With Hemodynamic Changes (SCoRCH) After Trimethoprim-Sulfamethoxazole Use

Case report: Savolitinib induced severe adverse reactions resembling septic shock in an HIV-1–positive patient with advanced non-small cell lung cancer

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