Trimethoprim/Sulfamethoxazole-Related Acute Psychosis in the Second Course of Treatment After a Stem Cell Transplant: Case Report and Literature Review

Hsiao, Hui‐Hua; Chu, Neng-Sheng; Tsai, Yu-Fen; Chang, Chih‐Hau; Lin, Sheng-Fung; Liu, Ta-Chih

doi:10.6002/ect.2013.0119

Cited by 4 publications

(2 citation statements)

References 11 publications

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“…The mean half-life of both drugs has been reported to be between 8 and 10 h, and thus, steady state concentrations are reached by 3 days, suggesting that levels of TMP-SMX increased to steady state to cause mental status changes in the patient presented here. [ 9 ] Symptoms abated 8 h or about one-half life after the drug was stopped; this timeline is consistent with the literature as most cases of TMP-SMX-induced psychosis begin within 3 days of drug initiation and resolve within 24 h.[ 10 ]…”

Section: Discussionsupporting

confidence: 81%

“…There are studies describing TMP-SMX-induced psychosis, which was initially thought to occur mostly in the elderly[ 2 11 ] or immunocompromised. [ 10 12 13 ] Three cases have been reported in healthy adults’ ages 18, 19, and 46 with no psychiatric history who developed visual and auditory hallucinations in response to TMP-SMX, leading one of them to shoot himself in the face. [ 1 3 14 ] Two of them were taking oral double-strength tablets (160 mg TMP/800 mg SMX) BID, whereas the patient described in this case took half that dose and still developed CNS side effects.…”

Section: Discussionmentioning

confidence: 99%

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Psychosis resulting from trimethoprim-sulfamethoxazole treatment for preseptal cellulitis

Iqbal

Luke²,

Ingram³

2022

Taiwan J Ophthalmol

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Trimethoprim-sulfamethoxazole (TMP-SMX) is a commonly used antimicrobial agent because of its low cost, diverse antimicrobial profile, and minimal severe adverse effects. A rare side effect is psychosis, a complication that has not been published in the ophthalmology literature. A 53-year-old female presented to the ophthalmology office with left upper eyelid erythema, focal tenderness, and discharge. She was diagnosed with preseptal cellulitis of the left upper lid and started on TMP-SMX. The next day, the patient's condition improved with reduced swelling and no discharge. However, 2 days later, she experienced visual hallucinations whereby worms were growing out of her left eye accompanied by theme-congruent tactile hallucinations. TMP-SMX was discontinued and substituted for clindamycin, and she reported resolution of her symptoms 8 h later. TMP-SMX has extensive cerebrospinal fluid penetration and causes a folic acid deficiency, which may explain the rare occurrence of neuropsychiatric side effects. This patient had a substance-induced psychosis, in which visual and tactile hallucinations began 3 days after taking TMP-SMX and resolved 8 h after discontinuation, a timeline consistent with the literature. Central nervous system toxicity is rare in nonelderly immunocompetent patients, with only three such cases reported in the literature. While visual and auditory hallucinations have been described previously, this is the first reported case of TMP-SMX-induced tactile hallucinations and unilateral visual hallucinations. Moreover, because TMP-SMX is a first-line agent commonly used to treat orbital and preseptal cellulitis, it is important for ophthalmologists to be aware of this atypical side effect, as it can be life threatening.

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Section: Discussionsupporting

confidence: 81%