Trimethoprim–sulfamethoxazole induced rash and fatal hematologic disorders

SummaryTrimethoprim–sulfamethoxazole (TMP–SMX) is a combination chemotherapeutic agent, a commonly used antibiotic. Adverse drug reactions occur in 6–8% of patients. Although, the most common adverse reactions include mild gastrointestinal distress and cutaneous events, also a wide range of hematological abnormalities have been ascribed to TMP–SMX. We report a 40-year-old male patient who developed an early onset neutropenia, thrombocytopenia, generalised rash and oral candidiasis after 5 days long TMP–SMX therapy. Although generalised rash may seen more and improves with discontinuation of the therapy; severe neutropenia, thrombocytopenia and oral candidiasis are seen very rare and rarely leads to fatality as it was in our case. Despite thrombocyte transfusions, whole blood transfusions, red cell concentrates and filgrastim therapy we lost our patient. We want to underline that although the TMP–SMX combination is usually well tolerated it can also lead to fatal complications.