Abstract
Trimethoprim-sulfamethoxazole (Septra) is a widely used antibiotic world-wide.The clinical use has been increasing in the pediatric population[1]. Septra has been associated with a broad array of drug associated reactions including gastrointestinal complaints, cutaneous reactions including Stevens-Johnson syndrome and toxic epidermal necrolysisand cytopenias including immune mediated thrombocytopenia[2]. Adverse reactions occur in 6-8% of patients. In the pediatric patient hospitalized for an adverse drug reaction priorexposure to Septra is found in 75% of patients [3].In the case presented we describe a cutaneous reaction to Septra clinically consistent with a Type2 hypersensitivity reaction with associated pancytopenia. Idiosyncratic reactions such as Type 2 hypersensitivity have rarely been reported with Septra exposure.These adverse drug reactions have infrequently been reported to be fatal [4].With the increasing use of Septra for the management of community acquired methicillin resistant Staphylococcus aureus of skin and soft tissue infections [5] clinicians will need to recognize this clinical complication.
Highlights
Trimethoprim-sulfamethoxazole (Septra) is a widely used antibiotic world-wide.The clinical use has been increasing in the pediatric population[1].Septra has been associated with a broad array of drug associated reactions including gastrointestinal complaints, cutaneous reactions including StevensJohnson syndrome and toxic epidermal necrolysisand cytopenias including immune mediated thrombocytopenia[2].Adverse reactions occur in 6-8% of patients
In the pediatric patient hospitalized for an adverse drug reaction priorexposure to Septra is found in 75% of patients [3].In the case presented we describe a cutaneous reaction to Septra clinically consistent with a Type2 hypersensitivity reaction with associated pancytopenia
Idiosyncratic reactions such as Type 2 hypersensitivity have rarely been reported with Septra exposure.These adverse drug reactions have infrequently been reported to be fatal [4].With the increasing use of Septra for the management of community acquired methicillin resistant Staphylococcus aureus of skin and soft tissue infections [5] clinicians will need to recognize this clinical complication
Summary
Trimethoprim-sulfamethoxazole (Septra) is a widely used antibiotic world-wide.The clinical use has been increasing in the pediatric population[1]. In the pediatric patient hospitalized for an adverse drug reaction priorexposure to Septra is found in 75% of patients [3].In the case presented we describe a cutaneous reaction to Septra clinically consistent with a Type hypersensitivity reaction with associated pancytopenia. Atthe time of presentation she had been on trimethoprimsulfamethoxazoletwice daily for 6 days and reported having missed 2-3 doses.This was her first known exposure to trimethoprim-sulfamethoxazole.The patient received a 125 mg dose of methylprednisolone (Solumedrol)and a hemogram demonstrated pancytopenia. A 5 cm by 5 cm hard, nontender nodule was palpable behind the right ear; no other lymphadenopathywas present.Based on the clinical characteristics of the rash we concluded the patient demonstrated a type II hypersensitivity reaction to trimethoprim-sulfamethoxazole.The drug was discontinued at admission. The patient remained in the hospital for two days, during which time she had modest clinical improvement.A hemogram three days after discharge indicated the patient’s bone marrow to be recovering (Table 1).She was contacted 13 days after discharge and reported that the rash was resolved, she was afebrile, and she had required no further treatment
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