复方磺胺甲噁唑致抗生素相关性脑病1例并文献复习

A case of antibiotic-associated encephalopathy induced by trimethoprim-sulfamethoxazole and literature review

1例74岁男性患者,因血管免疫母细胞性T细胞淋巴瘤化疗后继发耶氏肺孢子菌肺炎入院,于2021年7月12日予美罗培南(1 g,q 8 h,ivgtt)+注射用万古霉素(1 g,q 12 h,ivgtt)+注射用卡泊芬净(50 mg,qd,ivgtt)联合复方磺胺甲噁唑片(磺胺甲噁唑1200 mg/甲氧苄啶240 mg,q 6 h)抗感染治疗。7月18日患者出现精神障碍,临床排除疾病本身因素,停用美罗培南、万古霉素,减量使用复方磺胺甲噁唑片(磺胺甲噁唑800 mg/甲氧苄啶160 mg,q 6 h),7月20日患者再次出现精神异常,考虑为抗生素相关性脑病。予停用可疑药物复方磺胺甲噁唑片,并口服碳酸氢钠片(1 g,tid)碱化尿液,适当加强补液等对症治疗,2 d后患者精神症状得到缓解,至出院期间未复发。

A 74-year-old male patient with vascular immunoblastic T cell lymphoma who developed secondary Pneumocystis pneumonia after chemotherapy was hospitalized and treated with meropenem(1 g,q 8 h,ivgtt),vancomycin(1 g,q 12 h,ivgtt),caspofungin(50 mg,qd,ivgtt)and trimethoprim-sulfamethoxazole(TMP-SMZ)tablets(sulfamethoxazole 1200 mg/trimethoprim 240 mg,q 6 h)since July 12th,2021.He developed mental symptoms on July 18th,2021.After excluding pathological factors,meropenem and vancomycin were stopped and the dosage of TMP-SMZ was reduced to sulfamethoxazole 800 mg/trimethoprim 160 mg,q 6 h.But he developed mental symptoms again on July 20th.Antibiotic-associated encephalopathy was considered.And then TMP-SMZ was stopped and symptomatic treatment including oral sodium bicarbonate tablets(1 g,tid)to alkalize urine and liquid infusion were given to him.The mental symptoms alleviated in 2 days and did not reappear till discharge.