Trimethoprim-Sulfamethoxazole Induced Rash, Febrile Neutropenia and Aseptic Meningoencephalitis

Case Report

Austin J Clin Case Rep. 2015; 2(4): 1079.

Trimethoprim-Sulfamethoxazole Induced Rash, Febrile Neutropenia and Aseptic Meningoencephalitis

Vazquez de Lara F¹, Goins WP², Hernandez-Vila E³ and Hernandez-Vila EA³*

¹Department of Internal Medicine, Hospital Angeles Puebla, Mexico

¹Division of Infectious Diseases, Department of Medicine, Baylor College of Medicine, USA

³Department of Cardiology, Texas Heart Institute, USA

*Corresponding author: Eduardo Hernandez- Vila, Department of Cardiology, Texas Heart Institute, Houston, USA

Received: September 26, 2015; Accepted: October 30, 2015; Published: November 02, 2015


Trimethoprim-sulfamethoxazole (TMP-SMX) is a commonly prescribed antibiotic that is associated with a number of adverse reactions that can be potentially life threatening. We report a case of a 30-year-old woman who presented with rash, febrile neutropenia and aseptic meningoencephalitis after finishing a course of TMP-SMX. To our knowledge, this is the first report of an otherwise healthy patient presenting with these conditions simultaneously.

Keywords: Trimethoprim-sulfamethoxazole combination; Aseptic meningitis; Aseptic meningoencephalitis; Febrile neutropenia; Exanthema

Case Presentation

A 30-year-old woman presented to the emergency department with a pruritic rash and fever. Six days before presentation she underwent augmentation mammoplasty and abdominoplasty. The patient was started on doxycycline and trimethoprim-sulfamethoxazole (TMPSMX) three days prior to surgery and continued it five days postoperatively because of a previous history of recurrent impetigo with methicillin-resistant Staphylococcus aureus. During her last day of taking the antibiotic she developed a diffuse rash, fever and chills.

On admission her temperature was 37.8 °C, blood pressure 108/73, pulse 115 beats per minute, respiratory rate 16 per minute, and oxygen saturation 99% on room air. The patient had no significant past medical history. She denied headaches, vision changes, nausea or vomiting. She complained only of mild constipation. Physical examination revealed a blanching patchy rash distributed primarily in the face, back, chest and abdomen (Figure.1). Incision sites were without erythema, swelling, fluctuance or drainage. The remainder of her examination was unremarkable. Laboratory analysis revealed mild thrombocytopenia and marked leukopenia of 0.5 x 10³ cells/μl (Reference: 3.4-10.8 x 10³ cells/μl) with an absolute neutrophil count (ANC) of 0.22 x 10³ cells/μl (Reference: 1.4–7.0 x 10³ cells/μl). HSV and VZV PCR from CSF and initial screening for CMV and influenza were negative. The patient was admitted with the diagnosis of febrile neutropenia for which she received cefepime, vancomycin, and one dose of filgrastim, a granulocyte colony-stimulating factor (G-CSF) analog. TMP-SMX had already been discontinued prior to hospital admission.

Citation: Vazquez de Lara F, Goins WP, Hernandez-Vila E and Hernandez-Vila EA. Trimethoprim- Sulfamethoxazole Induced Rash, Febrile Neutropenia and Aseptic Meningoencephalitis. Austin J Clin Case Rep. 2015; 2(4): 1079. ISSN : 2381-912X