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• W4387248716 abstract "SESSION TITLE: Critical Care Case Report Posters 65 SESSION TYPE: Case Report Posters PRESENTED ON: 10/11/2023 12:00 pm - 12:45 pm INTRODUCTION: Sulfamethoxazole/trimethoprim (TMP-SMX) induced meningoencephalitis is a rare occurrence that has been documented 4 times in medical literature. Symptoms include fevers, altered mentation, seizures and focal neurologic deficits (FNDs). TMP-SMX induced meningoencephalitis should be considered in the differential diagnosis of a patient being treated with TMP-SMX and presenting with new FNDs. CASE PRESENTATION: A 32-year-old male with a past medical history of human immunodeficiency virus and acquired immune deficiency syndrome and cryptococcal meningitis (CM) who presented with status epilepticus (SE). On presentation, the patient was afebrile, tachycardic and hypertensive. Physical exam showed the patient to be nonresponsive, agonal breathing, a tongue laceration and a Glascow Coma Scale of 3. Computed Tomography (CT) head, cervical spine, and chest respectably showed no acute intercranial infarct, enhancing bilateral cervical neck lymph nodes, and aspiration. The patient was intubated in the emergency department for airway protection and antiepileptic drugs were started. Nonconvulsive SE was seen on electroencephalography (EEG). Lumbar puncture (LP) showed opening pressure of 24 mmHg and cryptococcal antigen (CrAg) positive cerebral spinal fluid (CSF), consistent with CM. The patient's mentation improved with fluconazole. His new baseline physical exam showed right side neglect, spontaneous movement and pain localization in left upper and lower extremities (LUE/LLE) and the ability to follow commands. On hospital day 7, TMP-SMX was started for antigen positive Pneumocystis pneumonia. Ten days following TMP-SMX initiation the patient had a gradual neurologic decline consisting of loss of sensation, movement and muscle tone in the LUE/LLE. Brain MRI and repeat EEG showed no acute findings. Repeat LP showed opening pressure 17 mmHg, elevated lymphocytes and protein. CSF culture was weakly positive for CrAg consistent with treatment response. TMP-SMX was discontinued, within 72 hours the patientt was able to track and follow commands with his left hand. DISCUSSION: We report a case of aseptic meningoencephalitis related to TMP-SMX. Given the rarity of TMP-SMX-induced encephalitis, it can be an easily missed diagnosis. Signs and symptoms mimic those of a central nervous system (CNS) infection which can lead to unnecessary testing. Clinicians should consider TPM-SMX induced meningoencephalitis when treating a patient with signs/symptoms of a CNS infection with negative cultures while taking TMP-SMX. Early diagnosis and discontinuation of TMP-SMX is the treatment. Improvement in neurologic exam can be seen within 48-72 hours after discontinuation. Further studies should investigate the pathogenetic mechanism of TMP-SMX-induced meningoencephalitis. CONCLUSIONS: Being aware of the potential risk for TMP-SMX induced meningoencephalitis is important for healthcare providers to help improve patient outcomes and inform treatment decisions. REFERENCE #1: Dalal, S. and Dalal, R. (2023). Trimethoprim/Sulfamethoxazole Induced Encephalopathy. The Journal of Medical Sciences, 8(1-4), pp.15–16. doi: https://doi.org/10.5005/jp-journals-10045-00221. REFERENCE #2: J Jha, Pinky & Stromich, Jeremiah & Cohen, Mallory & Wainaina, Jane. (2016). A Rare Complication of Trimethoprim-Sulfamethoxazole: Drug Induced Aseptic Meningitis. Case Reports in Infectious Diseases. 2016. 1-4. 10.1155/2016/3879406. DISCLOSURES: No relevant relationships by Jayna Gardner - Gray No relevant relationships by Johnathan Stephan No relevant relationships by Stefani Thompson" @default.
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• W4387248716 date "2023-10-01" @default.
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• W4387248716 title "SULFAMETHOXAZOLE/TRIMETHOPRIM (BACTRIM)-INDUCED ASEPTIC MENINGOENCEPHALITIS" @default.
• W4387248716 doi "https://doi.org/10.1016/j.chest.2023.07.1407" @default.
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