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)

1

I.b Pneumonitis (ILD)

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I.c Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia)

1

I.e Acute eosinophilic pneumonia (AEP)

1

I.f Acute fibrinous organizing pneumonia (AFOP)

1

II.a Pulmonary edema, noncardiogenic (NCPE)

1

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

1

X.a DRES syndrome - DRESS-like reaction

1

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

1

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

1

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)

2

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

1

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

7

Recurrence with rechallenge (rarely advisable)

8

Causality assessment

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