Allergy Asthma Respir Dis.  2014 Jul;2(3):218-221. 10.4168/aard.2014.2.3.218.

Successful desensitization of trimethoprim-sulfamethoxazole in Stenostrophomonas maltophilia osteomyelitis

• Kim S
• Lim KH
• Kang MG
• Park HK
• Cho SH
• Min KU
• Kim SH
• Chang YS

• KMID: 2262523
• DOI: http://doi.org/10.4168/aard.2014.2.3.218

Abstract

Stenotrophomonas maltophilia is an emerging pathogen associated with morbidity and mortality in hospitalized patients. The treatment of S. maltophilia infection is challenging because clinical isolates are frequently resistant to most antimicrobial agents except trimethoprim-sulfamethoxazole (TMP-SMX). S. maltophilia osteomyelitis is a rare disease and requires a prolonged treatment with TMP-SMX. Here, we report an interesting case of a patient with S. maltophilia osteomyelitis who developed a delayed hypersensitivity reaction during TMP-SMX treatment and successfully treated after desensitization. TMP-SMX desensitization should be considered in patients with hypersensitivity to TMP-SMX, especially when there are no effective alternative drugs in S. maltophilia infection.

Keyword

Immunologic desensitization; Hypersensitivity; Stenotrophomonas maltophilia; Trimethoprim-sulfamethoxazole combination

MeSH Terms

Anti-Infective Agents
Desensitization, Immunologic
Humans
Hypersensitivity
Hypersensitivity, Delayed
Mortality
Osteomyelitis*
Rare Diseases
Stenotrophomonas maltophilia
Trimethoprim, Sulfamethoxazole Drug Combination*
Anti-Infective Agents

Reference

1. Denton M, Kerr KG. Microbiological and clinical aspects of infection associated with Stenotrophomonas maltophilia. Clin Microbiol Rev. 1998; 11:57–80.

2. Absar N, Daneshvar H, Beall G. Desensitization to trimethoprim/sulfamethoxazole in HIV-infected patients. J Allergy Clin Immunol. 1994; 93:1001–1005.

3. Quirino T, Bonfanti P, Niero F, Rizzardini G, Iemoli E, Milazzo F. Desensitization to trimethoprim-sulfamethoxazole in patients infected with human immunodeficiency virus. Clin Infect Dis. 1996; 22:396.

4. Jick H. Adverse reactions to trimethoprim-sulfamethoxazole in hospitalized patients. Rev Infect Dis. 1982; 4:426–428.

5. Jung AC, Paauw DS. Management of adverse reactions to trimethoprim-sulfamethoxazole in human immunodeficiency virus-infected patients. Arch Intern Med. 1994; 154:2402–2406.

6. Lin D, Li WK, Rieder MJ. Cotrimoxazole for prophylaxis or treatment of opportunistic infections of HIV/AIDS in patients with previous history of hypersensitivity to cotrimoxazole. Cochrane Database Syst Rev. 2007; (2):CD005646.

7. Yilmaz M, Celik AF, Mert A. Successfully treated nosocomial Stenotrophomonas maltophilia bacteremia following desensitization to trimethoprim-sulfamethoxazole. J Infect Chemother. 2007; 13:122–123.

8. Baltimore RS, Jenson HB. Puncture wound osteochondritis of the foot caused by Pseudomonas maltophilia. Pediatr Infect Dis J. 1990; 9:143–144.

9. Landrum ML, Conger NG, Forgione MA. Trimethoprim-sulfamethoxazole in the treatment of Stenotrophomonas maltophilia osteomyelitis. Clin Infect Dis. 2005; 40:1551–1552.

10. Gruchalla RS. 10. Drug allergy. J Allergy Clin Immunol. 2003; 111:2 Suppl. S548–S559.

11. Schnyder B, Pichler WJ. Allergy to sulfonamides. J Allergy Clin Immunol. 2013; 131:256–257.e1-5.

12. Teraki Y, Shiohara T. Successful desensitization to fixed drug eruption: the presence of CD25+CD4+ T cells in the epidermis of fixed drug eruption lesions may be involved in the induction of desensitization. Dermatology. 2004; 209:29–32.