Johnson M P, Goodwin S D, Shands J W
Department of Medicine, College of Pharmacy, University of Florida, Gainesville.
Pharmacotherapy. 1990;10(6):413-6.
Adverse effects are common in patients with acquired immunodeficiency syndrome (AIDS) who receive trimethoprim-sulfamethoxazole (TMP-SMX). Two patients experienced a rare anaphylactoid syndrome. Within hours of receiving a double-strength TMP-SMX tablet, a 28-year-old human immunodeficiency virus (HIV)-positive man developed fever, hypotension, and bilateral pulmonary infiltrates. Broad-spectrum antimicrobial therapy was begun but discontinued 2 days later when signs and symptoms resolved and specimens for Pneumocystis carinii were negative. A 38-year-old man developed rash, fever, hypotension, hyperbilirubinemia, renal dysfunction, and bilateral pulmonary infiltrates after taking two doses of oral TMP-SMX. Several antimicrobial agents, including parenteral pentamidine, were administered despite lack of evidence for P. carinii or other infection. four case reports of similar reactions in patients with AIDS have been published. Notable differences exist between the syndrome described and anaphylaxis. The TMP-SMX anaphylactoid reactions in patients with AIDS mimic sepsis or opportunistic infection, thus making diagnosis difficult.
接受甲氧苄啶-磺胺甲恶唑（TMP-SMX）治疗的获得性免疫缺陷综合征（AIDS）患者中不良反应很常见。两名患者出现了罕见的类过敏综合征。一名28岁的人类免疫缺陷病毒（HIV）阳性男性在服用双倍剂量的TMP-SMX片剂数小时内，出现发热、低血压和双侧肺部浸润。开始了广谱抗菌治疗，但在2天后症状体征消退且卡氏肺孢子虫标本检测为阴性时停药。一名38岁男性在服用两剂口服TMP-SMX后出现皮疹、发热、低血压、高胆红素血症、肾功能不全和双侧肺部浸润。尽管没有卡氏肺孢子虫或其他感染的证据，仍使用了包括胃肠外喷他脒在内的几种抗菌药物。已发表了4例AIDS患者类似反应的病例报告。所描述的综合征与过敏反应之间存在显著差异。AIDS患者中的TMP-SMX类过敏反应类似败血症或机会性感染，因此因此诊断困难。
