2608. BW Mod.Medicine 02/1•1.6

We report a female patient who repeatedly developed pancreatitis after trimethoprim-sulfamethoxazole (TMP/SMX) use. During childhood she had undergone an ureterosigmoidostomy after which she had been on TMP/SMX 480 mg daily as prophylaxis for pyelonephritis for many years. The patient presented with abdominal pain caused by acute pancreatitis. No other cause, except for TMP/SMX use, could be identified. A causal relationship was confirmed by relapse of the pancreatitis after rechallenge. Our case is unique in demonstrating that acute pancreatitis related to the use of TMP/SMX may occur even after long-term treatment. We advise that the medication is discontinued immediately if a causal relationship with pancreatitis is suspected. K E Y W O R D S Co-trimoxazole, drugs, pancreatitis, rechallange, trimethoprim-sulfamathoxazole I N T R O D U C T I O N Drug-related acute pancreatitis remains an uncommon clinical entity. Some cases of pancreatitis associated with the use of trimethoprim-sulfamethoxazole (TMP/SMX) have been reported previously (table 1). In all of these, clinical symptoms occurred within days to weeks after the onset of treatment. We report a case that is unique in that acute pancreatitis occurred after many years of treatment with TMP/SMX. Furthermore, a causal relation was demonstrated by recurrent symptoms following drug rechallenge. © 2005 Van Zuiden Communications B.V. All rights reserved. J U L Y A U G U S T 2 0 0 5 , V O L . 6 3 , N O . 7 275 C A S E R E P O R T Recurrent pancreatitis after trimethoprimsulfamethoxazole rechallenge M.W.J. Versleijen, A.H.J. Naber, N.P. Riksen, G.J. Wanten, F.M.J. Debruyne Departments of Gastroenterology and Hepatology, and Urology, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, the Netherlands, tel.: +31 (0)24-361 47 60, fax: +31 (0)24-355 79 57, e-mail: [email protected], corresponding author Table 1 Documented case reports of TMP/SMX-induced acute pancreatitis Reference Indication for Daily TMP/SMX Onset (days) of Onset of pancreatitis TMP/SMX use treatment (mg) pancreatitis after after rechallenge start of TMP/SMX 1 Occipital abscess with 960/4800 7 3 Nocardia asteroids 2 Urinary tract infection 320/1600 Only hepatitis after ‘Several days’ (hepatitis first exposure and pancreatitis) 3 Ear infection 320/1600 5 No rechallenge 4 Occipital abscess with 1600/8000 42 No rechallenge Nocardia 5 Pneumocystis carinii 1280/6400 10 No rechallenge pneumonia (HIV pos.) 6 Pneumocystis carinii 900 6 No rechallenge pneumonia (HIV pos.)