SHM Converge Scientific Abstract ePoster Gallery-Acute Respiratory Distress Syndrome and TMP-SMX Exposure in a Healthy Adult

Pdf Summary

This case report describes a rare, severe pulmonary complication potentially caused by trimethoprim-sulfamethoxazole (TMP-SMX, Bactrim) in a previously healthy 26-year-old woman. TMP-SMX is a commonly prescribed antibiotic and is usually well tolerated, but rare lung injuries have been reported.<br /><br />The patient initially received TMP-SMX for a vaginal mass. By day 5, she developed signs of drug reaction, including fever, rash, myalgia, nausea, and leukopenia, and the drug was stopped. Over the next several days, she worsened and returned to the emergency department with dyspnea, chest pain, diarrhea, fatigue, and fever. She was first treated as having community-acquired pneumonia, but her condition progressed despite antibiotics. She became hypoxic, required intubation, and was transferred to a tertiary ICU.<br /><br />Her respiratory failure deteriorated into severe acute respiratory distress syndrome (ARDS). Extensive infectious and rheumatologic testing was negative, and no other cause for her illness could be identified. She ultimately required veno-venous ECMO and later bilateral lung transplantation, followed by discharge home after a prolonged hospitalization.<br /><br />The authors conclude that TMP-SMX–induced lung injury should be considered when otherwise healthy patients develop severe respiratory failure of unclear cause, especially after recent drug exposure. They emphasize the importance of a detailed medication history and note that more research is needed to understand the mechanism and guide treatment of this rare but potentially fatal reaction.

Asset Subtitle

Tracy Bui

Meta Tag

Author List Harini Shah, Pinky Jha, Tracy Bui, Valerie Carter

Category Clinical Vignettes

Concept Trimethoprim-sulfamethoxazole

Concept Pulmonary Toxicity

Concept Acute Respiratory Distress Syndrome

Concept Respiratory Failure

Concept Medication History

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Tracy Bui

Track Adult

Keywords

trimethoprim-sulfamethoxazole

TMP-SMX

Bactrim

drug-induced lung injury

acute respiratory distress syndrome

ARDS

veno-venous ECMO

lung transplantation

respiratory failure

adverse drug reaction

Trimethoprim-sulfamethoxazole

Pulmonary Toxicity

Acute Respiratory Distress Syndrome

Respiratory Failure

Medication History