Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2019 Jul 2;11(7):e5071.
doi: 10.7759/cureus.5071.

Trimethoprim-sulfamethoxazole Induced Pancytopenia: A Common Occurrence but A Rare Diagnosis

Priyanka Parajuli  1 , Abdisamad M Ibrahim  1 , Harris H Siddiqui  2 , Odalys Estefania Lara Garcia  1 , Manjari R Regmi  1
Affiliations
Case Reports

Trimethoprim-sulfamethoxazole Induced Pancytopenia: A Common Occurrence but A Rare Diagnosis

Priyanka Parajuli et al. Cureus. .

Abstract

Trimethoprim-sulfamethoxazole (TMP-SMX) is a bacteriostatic antimicrobial medication used for the treatment of a variety of infections and has many reported skin and hematologic side effects. Due to the easy availability and cost effectiveness, TMP-SMX is one of the medications commonly used for treatment of skin and soft tissue in patients with methicillin-resistant Staphylococcus aureus (MRSA) infection. One of the rare hematologic manifestations of TMP-SMX is pancytopenia, which is a reduction in all cell lines. In this case report, we are documenting a case of pancytopenia due to severe drug reaction to TMP-SMX in a 70-year-old female after two weeks of medication use. Upon initial stabilization she underwent a thorough workup and was subsequently diagnosed with severe drug-induced pancytopenia. Detailed history, early diagnosis, prompt discontinuation of the offending medication along with supportive care remain the mainstay of treatment in the management of TMP-SMX induced pancytopenia.

Keywords: bactrim; mrsa; pancytopenia; tmp-smx; trimethoprim sulfamethoxazole.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Diagnostic approach for patients presenting with pancytopenia of unknown etiology.
HIV, human immunodeficiency virus; CMV, cytomegalovirus; EBV, Epstein-Barr virus; HBV, hepatitis B virus; HCV, hepatitis C virus.
Figure 2
Figure 2. Differential diagnoses and expected findings in pancytopenia of various etiologies.
LDH, lactate dehydrogenase; TTP, thrombotic thrombocytopenic purpura; aPTT, activated partial thromboplastin time; ANC, absolute neutrophil count.
See this image and copyright information in PMC

References

    1. 46-year-old man with fevers, chills, and pancytopenia. Kelm DJ, Torres KM, Sohail MR. Mayo Clin Proc. 2012;87:799–802. - PMC - PubMed
    1. Evaluation and management of chronic pancytopenia. Sharma R, Nalepa G. Pediatr Rev. 2016 ;37:101–113. - PMC - PubMed
    1. Acute-onset pancytopenia in a previously healthy teenager. Crews J, Dawkins R. J Paediatr Neonatal Dis. 2016;1:105.
    1. Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Liu C, Bayer A, Cosgrove SE, et al. Infect Dis. 2011;52:0. - PubMed
    1. Sulfonamides and trimethoprim . Kalkut G. Cancer Invest. 2009;16:612–615. - PubMed

Publication types

LinkOut - more resources