Pneumotox » Drug » Trimethoprim sulfamethoxazole (TMP-SMX)

Trimethoprim sulfamethoxazole (TMP-SMX)

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Last update : 22/03/2022

I.a Pneumonitis (ILD), acute and/or severe (may cause ARDS)

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I.b Pneumonitis (ILD)

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I.c Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia)

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I.e Acute eosinophilic pneumonia (AEP)

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I.f Acute fibrinous organizing pneumonia (AFOP)

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I.ba Irreversible respiratory damage requiring lung Tx

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II.a Pulmonary edema, noncardiogenic (NCPE)

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II.b ARDS - Acute lung injury

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II.u Acute respiratory failure (e.g. from ARDS, ILD, PIE, OP, pulmonary edema or bronchospasm) requiring ECMO

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V.f Pneumothorax

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X.a DRES syndrome - DRESS-like reaction

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X.e Autoimmunity-Autoimmune conditions (+ANA, +anti-ds-DNA, +ANCAs, other auto-Abs)

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X.f Anaphylaxis-Anaphylactoid reaction (can be fatal)

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X.g Hypersensitivity reaction (may manifest with fever and/or skin, throat or airway involvement)

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X.x Subclinical ANCA positivity

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XIV.a Methemoglobinemia

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XV.b Path: Eosinophilic pneumonia (subacute or acute) (see also Ic)

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XV.f Path: Diffuse alveolar damage (DAD-pattern) (see also IL)

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XV.ct Path: Delayed alveolar injury with delayed epithelialization (DAIDE)

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XVI.bb Imaging: Pneumomediastinum

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XIX.c BAL: An excess proportion of eosinophils

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Diagnosing DIRD

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Drug and radiation history

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Drug singularity - Correct identification of the drug

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Consistent timing of exposure v. onset of symptoms

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Clinical, imaging, BAL, pathological pattern consistent with the specific drug

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Careful exlusion of another cause

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Remission of symptoms with removal of drug

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Recurrence with rechallenge (rarely advisable)

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Causality assessment

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