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Trimethoprim/sulfamethoxazole desensitization in an HIV-positive patient with previous Stevens-Johnson syndrome; a failed study

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Abstract

Drug-induced Stevens-Johnson syndrome (SJS) is a rare but life-threatening hypersensitivity reaction. Drug desensitization might be considered in drug-allergic patients with no therapeutic alternative. A 29-year-old man with a recent diagnosis of HIV and HBV (CD4 count: 4 cells/mm3) who has been receiving Trimethoprim/sulfamethoxazole (TMP/SMX) for Pneumocystis pneumonia (PCP) prophylaxis was admitted at Imam Khomeini hospital complex affiliated to Tehran University of Medical Sciences, with the diagnosis of SJS due to TMP/SMX. After 45 days of supportive care, the patient was a candidate for TMP/SMX desensitization due to our region’s unavailability of alternative agents. A 9-day desensitization protocol was used, but the patient complained about diarrhea with severe pain in the rectal mucosa, and macules developed over his lips again on the third day. As a result, the desensitization process immediately stopped, and after the signs and symptoms were resolved, the patient was discharged with Clindamycin tablet 600 mg TDS. Unfortunately, two weeks after discharge, the patient experienced acute kidney injury (AKI) and expired after two dialysis sessions.

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Data is available on request. Please contact namazisoha@yahoo.com.

References

  1. Wang Y, Huang X, Sun T, Fan G, Zhan Q, Weng L. Non-HIV‐infected patients with Pneumocystis pneumonia in the intensive care unit: a bicentric, retrospective study focused on predictive factors of in‐hospital mortality. Clin Respir J. 2022;16(2):152–61.

  2. Overgaard UM, Helweg-Larsen J. Pneumocystis jiroveci pneumonia (PCP) in HIV-1-negative patients: a retrospective study 2002–2004. Scandinavian journal of infectious diseases. 2007;39(6–7):589–95.

  3. Eldred LJ, Wu AW, Chaisson RE, Moore RD. Adherence to antiretroviral and pneumocystis prophylaxis in HIV disease. J Acquir Immune Defic Syndr Hum Retrovirol. 1998;18(2):117–25.

  4. Bozzette SA, Finkelstein DM, Spector SA, Frame P, Powderly WG, He W, Phillips L, Craven D, Van Der Horst C, Feinberg J. A randomized trial of three antipneumocystis agents in patients with advanced human immunodeficiency virus infection. N Engl J Med. 1995;332(11):693–9.

  5. Abtahi-Naeini B, Dehghan MS, Paknazar F, Shahmoradi Z, Faghihi G, Sabzghabaee AM, Akbari M, Hadian M, Momen T. Clinical and epidemiological features of patients with drug-induced Stevens-Johnson syndrome and toxic epidermal necrolysis in Iran: different points of children from adults. Int J Pediatr. 2022;2022.

  6. Mandel GL, Bennet JE. Bennett’s principles and practice of infectious diseases. Philadelphia: Churchill Livingstone. 2010;3495:522.

  7. Phillips E, Mallal S. Drug hypersensitivity in HIV. Curr Opin Allergy Clin Immunol. 2007;7(4):324–30.

  8. Schöpf E. Skin reactions to co-trimoxazole. Infection. 1987;15(5):254–8.

  9. Legendre DP, Muzny CA, Marshall GD, Swiatlo E. Antibiotic hypersensitivity reactions and approaches to desensitization. Clin Infect Dis. 2014;58(8):1140–8.

  10. Liu A, Fanning L, Chong H, Fernandez J, Sloane D, Sancho-Serra M, Castells M. Desensitization regimens for drug allergy: state of the art in the 21st century. Clin Exp Allergy. 2011;41(12):1679–89.

  11. Leoung GS, Stanford JF, Giordano MF, Stein A, Torres RA, Giffen CA, Wesley M, Sarracco T, Cooper EC, Dratter V, Smith JJ. Trimethoprim-sulfamethoxazole (TMP-SMZ) dose escalation versus direct rechallenge for Pneumocystis carinii pneumonia prophylaxis in human immunodeficiency virus—Infected patients with previous adverse reaction to TMP-SMZ. J Infect Dis. 2001;184(8):992–7.

  12. Douglas R, Spelman D, Czarny D, O’Hehir RE. Successful desensitization of two patients who previously developed Stevens-Johnson syndrome while receiving trimethoprim-sulfamethoxazole. Clin Infect Dis. 1997;25(6):1480.

  13. Montanaro A. Sulfonamide allergy in HIV-uninfected patients. UpToDate. http://www.helsebiblioteket.no/ (Sist oppdatert: 23. 2016 Sep.

  14. Dhali D, Halder U, Santra R, Biswas M. Cefixime induced Stevens-Johnson syndrome: a case report and review of literature. Int J Contemp Med Res. 2016;3(5):1426–7.

    Google Scholar 

  15. Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, Janecek E, Domecq C, Greenblatt DJ. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30(2):239–45.

  16. Sassolas B, Haddad C, Mockenhaupt M, Dunant A, Liss Y, Bork K, Haustein UF, Vieluf D, Roujeau JC, Le Louet H. ALDEN, an algorithm for assessment of drug causality in Stevens–Johnson syndrome and toxic epidermal necrolysis: comparison with case–control analysis. Clin Pharmacol Ther. 2010;88(1):60–8.

  17. Ioannidis JP, Cappelleri JC, Skolnik PR, Lau J, Sacks HS. A meta-analysis of the relative efficacy and toxicity of Pneumocystis carinii prophylactic regimens. Arch Intern Med. 1996;22(2):177–88.

  18. Beumont MG, Graziani A, Ubel PA, MacGregor RR. Safety of dapsone as Pneumocystis carinii pneumonia prophylaxis in human immunodeficiency virus-infected patients with allergy to trimethoprim/sulfamethoxazole. Am J Med. 1996;100(6):611–6.

  19. Yoshimura Y, Sakamoto Y, Amano Y, Tachikawa N. Case report: clindamycin with primaquine therapy for severe pneumocystis pneumonia. Kansenshogaku zasshi. J Japan Assoc Infect Dis. 2015;89(5):601–5.

  20. Rotunda AD. Severe cutaneous reactions associated with the use of human immunodeficiency virus medications. Acta Derm Venereol. 2003;83(1).

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Authors and Affiliations

  1. Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences (TUMS), Tehran, Iran

    Ramin Ansari & Soha Namazi

  2. Department of Infectious Disease, School of Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran

    Sara Ghaderkhani

  3. Research Center for Rational Use of Drugs, Tehran University of Medical Sciences (TUMS), Tehran, Iran

    Soha Namazi

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  1. Ramin Ansari
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Ansari, R., Ghaderkhani , S. & Namazi, S. Trimethoprim/sulfamethoxazole desensitization in an HIV-positive patient with previous Stevens-Johnson syndrome; a failed study. DARU J Pharm Sci 31, 69–73 (2023). https://doi.org/10.1007/s40199-023-00457-z

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