Haemophagocytic lymphohistiocytosis (HLH) in an adult following treatment with trimethoprim/sulfamethoxazole

Abstract

Haemophagocytic lymphohistiocytosis (HLH) is an aggressive hyperinflammatory haematological condition often associated with malignancy, infection or rheumatological disorders. HLH has rarely been associated with medications, including antibiotics. We describe a case of a patient without significant medical history who presented with HLH following treatment with trimethoprim/sulfamethoxazole (TMP/SMX). Additionally, we will discuss the possible mechanism of medication-induced HLH as well as the successful use of dexamethasone as the sole treatment. Early diagnosis and treatment of this disease is critical and medication-induced HLH should be considered in cases without a clear aetiology. To our knowledge, this is the first case report of TMP/SMX-induced HLH that was successfully treated with steroid monotherapy and just the second case report of TMP/SMX-induced HLH.

Drug-induced secondary haemophagocytic lymphohistiocytosis in hairy cell leukaemia

“…Other case reports of co-trimoxazole-induced HLH also occurred within 12 days of starting treatment and showed resolution of pyrexia 48-h post-steroid therapy. 9 This timeline aligns very closely with the onset and clinical response in our patient.…”

“…Similar to another published case report of drug-induced HLH, 9 our patient responded rapidly to steroid monotherapy and did not require second-line therapies.…”