Case Report
Year: 2023 | Month: March | Volume: 10 | Issue: 3 | Pages: 466-469
DOI: https://doi.org/10.52403/ijrr.20230353
Trimethoprim - Sulfamethoxazole Induced Sweet Syndrome: A Case Report
Riya Johns
Department of Pharmacy Practice, Bapuji Pharmacy College, Shamanur Road, S.S Layout, Davangere- 577004, Karnataka
ABSTRACT
Sweet syndrome (SS) also called as acute febrile neutrophilic dermatosis, is a rare inflammatory infectious skin reaction characterized clinically by tender, erythematous papules or plaque commonly appearing on the upper limbs, trunk, and head and neck. It is usually accompanied by fever and an elevation in the erythrocyte sedimentation rate (ESR), C- reactive protein. SS is classically triggered by infections, inflammatory bowel disease, pregnancy, malignancy or due to the administration of an associated drugs. Drug induce sweet syndrome (DISS) an uncommon subtype of SS. Drugs like antiepileptics like carbamazepine, diazepam, antibiotics like trimethoprim-sulfamethoxazole (TMP-SMX), minocycline, nitrofurantoin, norfloxacin, ofloxacin, contraceptives, non-steroidal anti-inflammatory drugs (NSAIDS) (celecoxib and diclofenac) and granulocyte – colony stimulating factor are the most common culprit. In this case, the patient was presented with oedematous and pustular eruption of nose with a rapid extension to the face, neck, upper trunk and the limbs which developed after taking TMP-SMX for 10 days accompanied with fever (42ºC) and cough. Laboratory test disclosed elevated WBC with notable increase in polymorphonuclear cells ,elevation of ESR (96mm/h), C-reactive protein (85ng/l, normal <5) and α-2-globulin (10g/l, normal <8). All these presentations clearly indicated that the patient is having DISS as per Walker and Cohen criteria for SS. TMP-SMX was discontinued upon which the lesions started to disappear. Clinical pharmacist must be more aware about the usage of TMP-SMX especially in immune compromised patients.
Keywords: Drug induced sweet syndrome, Trimethoprim-sulfamethoxazole, Neutrophilic infiltration, Corticosteroids, oedematous papules,
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