Liu Patricia, Ranches Gregory P, Gold Jeffrey A
Department of Internal Medicine, Oregon Health & Science University, VA P-3-GP1, block 4, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239-3098, USA.
Division of Pulmonary and Critical Care Medicine, Oregon Health & Science University, Portland, Oregon, USA.
BMC Pharmacol Toxicol. 2018 Nov 20;19(1):76. doi: 10.1186/s40360-018-0269-3.
Severe systemic reactions resembling septic shock have been described following trimethoprim-sulfamethoxazole (TMP-SMX) administration. Nearly all cases described in the literature occurred in HIV-infected patients.
We present a 42-year-old woman with a history of systemic lupus erythematosus (SLE) who was admitted to the Intensive Care Unit (ICU) twice with fever and circulatory shock after taking a dose of TMP-SMX 800-160 mg. She had no respiratory distress, urticarial rash or eosinophilia on presentation. Infectious workup during both admissions was negative and treatment with antibiotics, steroids and vasopressors was de-escalated with clinical improvement. She was found to be HIV negative, however, labs revealed a low CD4+ count.
TMP-SMX can rarely result in a severe, non-anaphylactic circulatory shock; if initially unrecognized, patients may undergo repeat drug exposure with an associated high morbidity risk. While more commonly reported in HIV individuals, this case demonstrates that TMP-SMX related circulatory shock can occur in a HIV negative patient.
服用甲氧苄啶-磺胺甲恶唑（TMP-SMX）后曾有类似感染性休克的严重全身反应的报道。文献中描述的几乎所有病例均发生在HIV感染患者中。
我们报告一名42岁有系统性红斑狼疮（SLE）病史的女性，在服用一剂800 - 160mg的TMP-SMX后因发热和循环性休克两次入住重症监护病房（ICU）。入院时她没有呼吸窘迫、荨麻疹皮疹或嗜酸性粒细胞增多。两次住院期间的感染检查均为阴性，随着临床症状改善，抗生素、类固醇和血管加压药的治疗逐渐减量。她的HIV检测为阴性，但实验室检查显示CD4 +细胞计数较低。
TMP-SMX很少会导致严重的非过敏性循环性休克；如果最初未被识别，患者可能会再次接触该药物，伴有较高的发病风险。虽然这种情况在HIV感染者中更常见，但该病例表明TMP-SMX相关的循环性休克也可发生在HIV阴性患者中。
