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Aseptic meningitis, hepatitis and cholestasis induced by trimethoprim/sulfamethoxazole: a case report

BACKGROUND: Drug-induced aseptic meningitis is a rare, but challenging diagnosis, most commonly reported with nonsteoroidal anti-inflammatory drugs (NSAIDs) and antibiotics. Trimethoprim/sulfamethoxazole (TMP/SMX) is a sulfonamide that is widely used in clinical practice for the treatment and prophy...

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Autores principales: van Asperdt, J. A. A., De Moor, R. A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8365906/
https://www.ncbi.nlm.nih.gov/pubmed/34399711
http://dx.doi.org/10.1186/s12887-021-02820-y
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author van Asperdt, J. A. A.
De Moor, R. A.
author_facet van Asperdt, J. A. A.
De Moor, R. A.
author_sort van Asperdt, J. A. A.
collection PubMed
description BACKGROUND: Drug-induced aseptic meningitis is a rare, but challenging diagnosis, most commonly reported with nonsteoroidal anti-inflammatory drugs (NSAIDs) and antibiotics. Trimethoprim/sulfamethoxazole (TMP/SMX) is a sulfonamide that is widely used in clinical practice for the treatment and prophylaxis of various infections. The most common side effects associated with TMP/SMX are generally mild and self-limited, but serious side effects have been reported, including liver injury and aseptic meningitis. CASE PRESENTATION: We report a 2,5 year old Dutch girl with both drug-induced aseptic meningitis and drug-induced liver injury while using TMP/SMX prophylaxis. Ursodeoxycholic acid was started because of cholestatic injury. After cessation of TMP/SMX, full convalescence was reached within weeks. CONCLUSIONS: This is the first report of a young patient with both aseptic meningitis and drug-induced liver injury caused by TMP/SMX. Drug-induced aseptic meningitis and cholestatic hepatitis constitute a considerable diagnostic challenge to clinicians. In addition to a thorough evaluation for infectious causes, clinicians should be aware of drug-induced aseptic meningitis and cholestatic hepatitis. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12887-021-02820-y.
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spelling pubmed-83659062021-08-17 Aseptic meningitis, hepatitis and cholestasis induced by trimethoprim/sulfamethoxazole: a case report van Asperdt, J. A. A. De Moor, R. A. BMC Pediatr Case Report BACKGROUND: Drug-induced aseptic meningitis is a rare, but challenging diagnosis, most commonly reported with nonsteoroidal anti-inflammatory drugs (NSAIDs) and antibiotics. Trimethoprim/sulfamethoxazole (TMP/SMX) is a sulfonamide that is widely used in clinical practice for the treatment and prophylaxis of various infections. The most common side effects associated with TMP/SMX are generally mild and self-limited, but serious side effects have been reported, including liver injury and aseptic meningitis. CASE PRESENTATION: We report a 2,5 year old Dutch girl with both drug-induced aseptic meningitis and drug-induced liver injury while using TMP/SMX prophylaxis. Ursodeoxycholic acid was started because of cholestatic injury. After cessation of TMP/SMX, full convalescence was reached within weeks. CONCLUSIONS: This is the first report of a young patient with both aseptic meningitis and drug-induced liver injury caused by TMP/SMX. Drug-induced aseptic meningitis and cholestatic hepatitis constitute a considerable diagnostic challenge to clinicians. In addition to a thorough evaluation for infectious causes, clinicians should be aware of drug-induced aseptic meningitis and cholestatic hepatitis. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12887-021-02820-y. BioMed Central 2021-08-16 /pmc/articles/PMC8365906/ /pubmed/34399711 http://dx.doi.org/10.1186/s12887-021-02820-y Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Case Report
van Asperdt, J. A. A.
De Moor, R. A.
Aseptic meningitis, hepatitis and cholestasis induced by trimethoprim/sulfamethoxazole: a case report
title Aseptic meningitis, hepatitis and cholestasis induced by trimethoprim/sulfamethoxazole: a case report
title_full Aseptic meningitis, hepatitis and cholestasis induced by trimethoprim/sulfamethoxazole: a case report
title_fullStr Aseptic meningitis, hepatitis and cholestasis induced by trimethoprim/sulfamethoxazole: a case report
title_full_unstemmed Aseptic meningitis, hepatitis and cholestasis induced by trimethoprim/sulfamethoxazole: a case report
title_short Aseptic meningitis, hepatitis and cholestasis induced by trimethoprim/sulfamethoxazole: a case report
title_sort aseptic meningitis, hepatitis and cholestasis induced by trimethoprim/sulfamethoxazole: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8365906/
https://www.ncbi.nlm.nih.gov/pubmed/34399711
http://dx.doi.org/10.1186/s12887-021-02820-y
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