Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore.
Singapore Med J. 2013 May;54(5):e113-6. doi: 10.11622/smedj.2013067.
Trimethoprim-sulfamethoxazole (TMP-SMZ) is a commonly used antibiotic that has been associated with drug rash with eosinophilia and systemic symptoms (DRESS) syndrome. DRESS syndrome is characterised by fever, rash, lymphadenopathy, eosinophilia and one or more major organ involvement. Although rare, TMP-SMZ is a recognised cause of fulminant hepatic failure. We report a 17-year-old Chinese male adolescent who presented with fever, myalgia, generalised maculopapular rash and lymphadenopathy after taking TMP-SMZ for acne vulgaris. He subsequently developed hepatic encephalopathy and was worked up for urgent liver transplantation. He responded well to extracorporeal liver dialysis (originally intended as a bridging therapy) and subsequently recovered without the need for liver transplantation. This case report highlights the importance of early recognition of TMP-SMZ-induced DRESS syndrome and the need for early discontinuation of the drug in the affected patient. Extracorporeal liver dialysis and transplantation should be considered in the management of TMP-SMZ-induced fulminant hepatic failure.
甲氧苄啶-磺胺甲噁唑（TMP-SMZ）是一种常用的抗生素，与药物性皮疹伴嗜酸粒细胞增多和全身症状（DRESS）综合征有关。DRESS 综合征的特征是发热、皮疹、淋巴结病、嗜酸粒细胞增多和一个或多个主要器官受累。虽然罕见，但 TMP-SMZ 是暴发性肝衰竭的公认原因。我们报告了一名 17 岁的中国男性青少年，在因寻常痤疮服用 TMP-SMZ 后出现发热、肌痛、全身性斑丘疹和淋巴结病。他随后出现肝性脑病，并进行紧急肝移植检查。他对体外肝脏透析（最初用作桥接治疗）反应良好，随后无需肝移植即可康复。本病例报告强调了早期识别 TMP-SMZ 诱导的 DRESS 综合征以及在受影响患者中早期停用该药物的重要性。在 TMP-SMZ 诱导的暴发性肝衰竭的治疗中，应考虑体外肝脏透析和移植。
