Association of Hepatic Necrosis With Trimethoprim Sulfonamide Administration in 4 Dogs

Abstract

Hepatic necrosis in association with trimethoprim-sulfonamide (TMS) combination therapy was diagnosed in 4 dogs based on history, clinical presentation, and examination of histopathologic specimens collected postmortem. Duration of TMS therapy prior to onset of clinical signs ranged from 4 to 30 days. The dose of TMS ranged from 18 mg/kg to 53 mglkg bid. Despite supportive medical therapy, all dogs died or were eurimethoprim-sulfonamide (TMS) combination antibiotic T agents commonly are used in veterinary medicine to treat a variety of infectious diseases. Although adverse reactions are infrequent, polyarthritis, skin eruptions, aplastic anemia, keratoconjunctivitis sicca, fever, leukopenia, thrombocytopenia, polymyositis, and glomerulonephropathy have been reported in association with TMS therapy in dogs.'-' Hepatic necrosis has been associated with sulfonamide therapy in humans.'"-28 In addition, reversible cholestatic hepatitis has been described in people receiving TMS.'4.1"18 The purpose of this report is to describe hepatic necrosis associated with TMS therapy in 4 dogs. Clinical data for each dog are summarized in Table 1. Case ReportsDog 1. A 27-kg, I-year-old male Labrador Retriever was referred for emergency therapy of acute liver failure. There was no history of toxin exposure, the dog was current on vaccinations, and there had been no previous illnesses. Three weeks prior to referral, the dog began coughing soon after boarding in a kennel. A tentative diagnosis of tracheobronchitis was made, and therapy with trimethoprim-sulfadiazine (Tribrissen; Coopers Animal Health, Kansas City, KS), (53 m g k g PO bid) was initiated. Three days after initiation of therapy the dog became lethargic and was presented again to the referring veterinarian. During the next 24 hours, the dog became icteric and developed bilateral epistaxis and hematochezia. The dog was then referred to us for emergency care. Physical examination revealed a semicomatose patient with bilateral epistaxis, icterus, and injected mucous membranes. Given the poor prognosis, the owners elected euthanasia, and a postmortem examination was performed.Grossly, the liver was dark red with multiple yellow and pink coalescing areas. Histopathologic examination of the liver revealed marked, widespread, acute, submassive to massive periaciiiar and midzonal necrosis with resultant dilation of sinusoids, and associated congestion and hemorrhage. Mild, multifocal, lymphoplasmacytic infiltrates were found in several centriacinar regions. bile duct ectasia or accumulation of inspissated bile was noted in larger radicals A 22.6-kg, 6-month-old male Samoyed presented with lethargy and icterus. The dog had no history of previous illness until 3 weeks prior to presentation to the referring veterinarian when the dog started coughing. A tentative diagnosis of infectious tracheobronchitis was made, and the dog was treated with trimethoprimsulfamethoxazole (Bactrim; Roche Pharmaceuticals, Nutley, NJ), (21 mg/kg PO bid) for 1 week. The dog was re-evaluated because the...

Clinical Findings in 40 Dogs with Hypersensitivity Associated with Administration of Potentiated Sulfonamides

“…Most of the dogs with hepatopathy in this study developed hepatic necrosis, although severe cholestasis and lymphoplasmacytic inflammation were also noted in some individuals, as has been reported in humans and in other dogs. [20][21][22] Serial liver histopathology samples in one dog indicated resolution of hepatic necrosis 12 after treatment with the glutathione precursor N-acetylcysteine. Another dog for which sulfonamides were continued, despite the onset of a fever during treatment, survived the initial hepatopathy but had persistent increases in ALT (7-fold) at least 6 months after the reaction.…”

Idiosyncratic toxicity associated with potentiated sulfonamides in the dog

“…, 1992). The most common reported finding on histopathology is marked hepatic necrosis (Thornburg, 1988; Thomson, 1990; Bureau of Veterinary Drugs, 1995; Twedt et al. , 1997), although marked cholestasis or marked lymphoplasmacytic inflammation have also been observed (Rowland et al.…”

“…The clinical pattern may be acute parenchymal damage with moderate to severe increases in serum alanine aminotransferase (ALT) activity, acute cholestasis with jaundice, or a combination of the two (Toth & Derwelis, 1980;Anderson et al, 1984;Rowland et al, 1992). The most common reported finding on histopathology is marked hepatic necrosis (Thornburg, 1988;Thomson, 1990;Bureau of Veterinary Drugs, 1995;Twedt et al, 1997), although marked cholestasis or marked lymphoplasmacytic inflammation have also been observed (Rowland et al, 1992;Trepanier et al, 2003a).…”

Investigation on the Counteracting Effect of Spirulina Against Potentated Sulfonamide’s (Cotrim Ds®) Side Effects in Rat

“…These have adverse reactions in elderly patients including severe skin reactions, generalized bone marrow suppression and decreased platelets (Agarwal, 1992). Moreover, these have gastrointestinal side effects (Bulgin et al, 1991), hypersensitivity side effects (Noli et al, 1995), hematologic side effects (Weiss and Adams, 1987), renal side effects (Duffee et al, 1984) and hepatic side effects (Twedt et al, 1997).…”