Document Detail

Severe hepatotoxicity and probable hepatorenal syndrome associated with sulfadiazine.
MedLine Citation:
PMID:  21546639     Owner:  NLM     Status:  MEDLINE    
SUMMARY: A 20-year-old Caucasian woman weighing 59 kg was admitted to the infectious diseases ward of a hospital in May 2009 with nausea, vomiting, and jaundice. In March 2009, she was diagnosed with toxoplasmosis retinitis and received sulfadiazine 3 g daily, pyrimethamine 50 mg daily, leucovorin 15 mg daily, and prednisolone 75 mg daily; she continued these medications for three weeks. After the development of gastrointestinal symptoms, she stopped taking the prescribed medications (five days before hospital admission). One day before hospital admission, her skin appeared jaundiced. At the time of admission, the patient had high transaminase levels, hyperbilirubinemia, abnormal prothrombin time and International Normalized Ratio values, and clinical evidence of acute fulminant hepatitis complicated by hepatorenal syndrome. Autoimmune hepatitis was excluded as a cause of her hepatotoxicity, as was Wilson's disease, herpes simplex virus, cytomegalovirus, hepatitis A virus, hepatitis E virus, and Epstein-Barr virus. She was diagnosed with probable drug-related fulminant hepatitis, presumably caused by sulfadiazine treatment. Lactulose 20 g was started for the prevention of encephalopathy. She received phytonadione 10 mg daily for three consecutive days, ranitidine 50 mg thrice daily, ciprofloxacin 250 mg twice daily, and acetylcysteine 600 mg thrice daily. The patient underwent hemodialysis five times during her hospital stay. Her symptoms gradually improved, and she was discharged on hospital day 20.
CONCLUSION: Probable hepatorenal syndrome requiring hemodialysis occurred in a patient receiving sulfadiazine for the treatment of toxoplasmosis retinitis.
Hossein Khalili; Abdolreza Soudbakhsh; Azita Hajhossein Talasaz
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists     Volume:  68     ISSN:  1535-2900     ISO Abbreviation:  Am J Health Syst Pharm     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-05-06     Completed Date:  2011-09-29     Revised Date:  2013-05-20    
Medline Journal Info:
Nlm Unique ID:  9503023     Medline TA:  Am J Health Syst Pharm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  888-92     Citation Subset:  IM    
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MeSH Terms
Antiprotozoal Agents / administration & dosage,  toxicity*
Hepatorenal Syndrome / chemically induced*
Liver / drug effects*,  physiopathology
Outcome Assessment (Health Care)
Sulfadiazine / administration & dosage,  toxicity*
Toxoplasmosis, Ocular / drug therapy
Young Adult
Reg. No./Substance:
0/Antiprotozoal Agents; 68-35-9/Sulfadiazine

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