SHM Converge Scientific Abstract ePoster Gallery-Severe Hypoglycemia Induced by Trimethoprim/Sulfamethoxazole in a Malnourished Non-Hiv Patient With Presumed Pneumocystis Pneumonia

Severe Hypoglycemia Induced by Trimethoprim/Sulfamethoxazole in a Malnourished Non-Hiv Patient With Presumed Pneumocystis Pneumonia

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This case report describes a 60-year-old severely malnourished man with alcohol use disorder who was admitted with profound anemia, vitamin deficiencies, dehydration, acute kidney injury, and suspected Wernicke’s encephalopathy. He initially received transfusion, vitamin replacement, and supportive care.<br /><br />On hospital day 6, he developed hypoxemia and bilateral pneumonia on CT. Because β-D-glucan was elevated and HIV testing was negative, Pneumocystis pneumonia (PCP) was suspected despite the absence of bronchoscopy. He improved after treatment with trimethoprim/sulfamethoxazole (TMP-SMX) and prednisolone, with TMP-SMX dose adjusted for renal function.<br /><br />However, after about two weeks of TMP-SMX, he developed progressive and severe hypoglycemia, reaching 20 mg/dL despite glucose infusion. Elevated insulin levels were found, but imaging did not show insulinoma. TMP-SMX-induced hypoglycemia was suspected, the drug was stopped, and his glucose and insulin levels normalized the next day. He recovered with continued nutritional support and rehabilitation and was discharged home independently.<br /><br />The authors highlight two main points: severe malnutrition in non-HIV patients may predispose them to PCP, and TMP-SMX can cause dangerous hypoglycemia, especially in patients with renal dysfunction or poor nutritional status.

Asset Subtitle

Iori Motohashi

Meta Tag

Author List Chiaki Okuse, Iori Motohashi, Kenya Ie, Yoshiyuki Ohira

Category Clinical Vignettes

Concept Pneumocystis jirovecii pneumonia

Concept Trimethoprim-sulfamethoxazole

Concept Hypoglycemia

Concept Medication-Related Hypoglycemia

Concept Severe Malnutrition

Distinguished Non-Finalist

Presenter Organization Department of General Internal Medicine, Kawasaki Municipal Tama Hospital

Presenting Author Iori Motohashi

Track Adult

Keywords

severe malnutrition

alcohol use disorder

profound anemia

Pneumocystis pneumonia

TMP-SMX

hypoglycemia

renal dysfunction

vitamin deficiencies

Wernicke encephalopathy

case report

Pneumocystis jirovecii pneumonia

Trimethoprim-sulfamethoxazole

Hypoglycemia

Medication-Related Hypoglycemia

Severe Malnutrition