Teo C P, Oh V M, Kueh Y K
Department of Medicine, National University Hospital, Singapore.
Ann Acad Med Singap. 1989 May;18(3):307-10.
We report a case of prolonged fever, agranulocytosis, and anaemia associated with the long acting sulphametopyrazine-trimethoprim combination (Kelfiprim). A woman of 23 years took an overdose of 13 tablets over five days for presumed cystitis. One day after the last dose the patient developed fever and a generalised rash. The fever persisted and her previously normal leukocyte count decreased to 1.8 x 10(9)/1. After treatment with paracetamol the fever settled briefly, and then recurred for another 16 days. A later peripheral blood leukocyte count of 0.77 x 10(9)/1, haemoglobin of 10.8 g/dl, and a hypocellular bone marrow with depressed granulopoiesis and haemopoiesis suggested marrow suppression induced by sulfametopyrazine. Since the IgM antibody against the Epstein-Barr virus capsid antigen was detected, the adverse drug reaction might have been aggravated by this virus. The case highlights the risk of severe haematological adverse reactions associated with sulphonamide treatment, and argues for the use of trimethoprim alone for uncomplicated cystitis.
我们报告一例与长效磺胺甲氧嗪 - 甲氧苄啶组合制剂（Kelfiprim）相关的长期发热、粒细胞缺乏症和贫血病例。一名23岁女性因疑似膀胱炎在五天内过量服用了13片该药物。最后一剂服药一天后，患者出现发热和全身性皮疹。发热持续，其先前正常的白细胞计数降至1.8×10⁹/L。用对乙酰氨基酚治疗后，发热短暂消退，随后又复发了16天。后来外周血白细胞计数为0.77×10⁹/L，血红蛋白为10.8 g/dl，骨髓细胞减少，粒细胞生成和造血功能受抑制，提示磺胺甲氧嗪引起骨髓抑制。由于检测到针对EB病毒衣壳抗原的IgM抗体，该病毒可能加重了药物不良反应。该病例突出了磺胺类药物治疗相关严重血液学不良反应的风险，并主张单纯使用甲氧苄啶治疗单纯性膀胱炎。
