Abstract
Abstract
Trimethoprim-sulphamethoxazole (TMP-SMZ) is considered a safe drug for treatment of infectious bacterial diseases in children. Side-effects are rare and generally take the form of a hypersensitivity reaction to the sulphamethoxazole component of the drug. Hepatic injury usually presents as a transient elevation of liver enzymes, which is of little clinical relevance. Fulminant liver failure due to TMP-SMZ has been reported in only six adults and never in children. We here report a 5-year-old girl who developed fulminant liver failure 3 weeks after her third exposure to TMP-SMZ. After a biphasic clinical course she underwent successful liver transplantation.
Conclusion
Trimethoprim-Sulphamethoxazole may cause fulminant liver failure in children. The disease can run a biphasic clinical course and liver transplantation must be considered as the therapeutic option for these patients.
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Abbreviations
- TMP-SM2 :
-
trimethoprim-sulphamethoxazole
References
Alberti-Flor JJ, Hernandez ME, Ferrer JP, et al (1989) Fulminant liver failure and pancreatitis associated with the use of sulfamethoxazole-trimethoprim. Am J Gastroenterol 84: 1577–1579
Burdelski M, Oellerich M, Düwel J, et al (1992) Pre- and post-transplant assessment of liver function in pediatric liver transplantation. Eur J Pediatr 151 [Suppl 1]: S39-S43
Devictor D, Deplanques L, Debray D, et al (1992) Emergency liver transplantation for fulminant liver failure in infants and children. Hepatology 16: 1156–1162
Endres W, Sierek T, Shin YS (1988) Clinical course of hereditary fructose intolerance in 56 patients. Acta Paediatr Jpn 30: 452–456
Horak J, Mertl L, Hrabal P (1984) Severe liver injuries due to sulfamethoxazole-trimetoprim and sulfamethoxydiazin. Hepatogastroenterol 31: 199–200
Mazziotta MRM, Ricci E, Bertini E, et al (1992) Fatal infantile liver failure associated with mitochondrial DNA depletion. J Pediatr 121: 896–901
Ransohoff DF, Jacobs G (1981) Terminal hepatic failure following a small dose of sulfamethoxazole-trimethoprim. Gastroenterology 80: 816–819
Samson JF, Barth PG, Vries JIP de, Menko FH, Ruitenbeck W, Ooost BA van, Jakobs C (1994) Familial mitochondrial encephalopathy with fetal ultrasonographic ventriculomegaly and intracerebral calcifications. Eur J Pediatr 153: 510–516
Sherlock S (1986) The spectrum of hepatotoxicity due to drugs. Lancet II: 440–444
Stricker BHC, Spoelstra P (1989) Drug-induced hepatic injury. In: Dukes MNG, (ed) Drug-induced disorders. Elsevier, Amsterdam, pp 1177–1182
Whitington PF, Balistreri WF (1991) Liver transplantation in pediatrics: Indications, contraindications, and pretransplant management. J Pediatr 118: 169–177
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Simma, B., Meister, B., Deutsch, J. et al. Fulminant hepatic failure in a child as a potential adverse effect of trimethoprim-sulphamethoxazole. Eur J Pediatr 154, 530–533 (1995). https://doi.org/10.1007/BF02074828
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DOI: https://doi.org/10.1007/BF02074828