A23 A CASE OF ACUTE LIVER DYSFUNCTION DUE TO TRIMETHOPRIM-SULFAMETHOXAZOLE TREATED WITH N-ACETYLCYSTEINE
Bibliographic record
Abstract
Trimethoprim-sulfamethoxazole (TMP-SMX) is commonly prescribed for skin and soft tissue infections. While generally well tolerated in HIV-negative patients, TMP-SMX can lead to drug-induced liver injury (DILI). Most cases are self-limited and resolve quickly with drug discontinuation, but prolonged, severe injury and liver failure can occur. Upon onset of acute liver failure, prognosis is poor without liver transplantation. Currently, there are no specific therapies to prevent progression to acute liver failure in patients with TMP-SMX induced liver injury. We hope to help raise awareness on DILI due to TMP-SMX and provide evidence for the use of N-acetylcysteine (NAC) to treat acute drug induced liver dysfunction. We report a case of a young male on TMP-SMX for a purulent soft tissue infection who developed acute liver dysfunction and was successfully treated with NAC. A 17 yo male was prescribed oral TMP-SMX (80 mg/400 mg) for a purulent soft tissue infection and after 30 days of treatment developed jaundice and a rash. He presented to the emergency department with accompanying malaise, weakness, nausea, vomiting and fever. He had no risk factors for viral hepatitis, no history of liver disease, took no other medications and did not drink alcohol or use recreational drugs. Laboratory tests showed elevated total bilirubin (139 µmol/L), transaminases (AST 280 U/L, ALT 1378 U/L), alkaline phosphatase (295 U/L), and lactate dehydrogenase (1162 U/L), with normal white blood cell count (9.6 x 109/L), serum albumin (38 g/L) and INR (1.1). Tests for hepatitis A, B and C were negative. Abdominal ultrasound found no evidence of biliary obstruction. His TMP-SMX was stopped but his condition worsened and he was transferred to our centre for urgent hepatology assessment. Physical examination revealed scleral icterus and a morbilliform rash over his trunk, back and upper extremities, but no asterixis. Repeat laboratory tests showed increased bilirubin (229 µmol/L), transaminases (AST 1498 U/L, ALT 2045 U/L), lactate dehydrogenase (5302 U/L) and INR (3.2). He underwent a transplant work-up, which did not reveal an alternative cause for his liver dysfunction. He received IV NAC for 72 hours and 4 doses of 10 mg IV vitamin K. NAC was dosed according to our standardized 20-hour protocol and the final infusion rate was continued until his INR was less than 1.5. After 4 days, his INR normalized, his rash and jaundice resolved and he was feeling well enough to be discharged home. Clinicians prescribing TMP-SMX should monitor patients for signs and symptoms of DILI. In the event of acute liver dysfunction due to TMP-SMX, use of NAC may improve outcomes by preventing progression to liver failure, but further research is needed. None
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.005 | 0.003 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".