Negative myoclonus associated with high-dose trimethoprim-sulfamethoxazole for treating Nocardia brain abscess

Takahiro Makino; Kazuki Machino; Naoto Nakazawa; Ikuo Kamitsukasa

doi:10.5692/clinicalneurol.cn-002225

January 1, 2026Rinsho ShinkeigakuOpen Access

Negative myoclonus associated with high-dose trimethoprim-sulfamethoxazole for treating Nocardia brain abscess

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Key Points

To explore the relationship between high-dose trimethoprim-sulfamethoxazole treatment and the onset of negative myoclonus in a patient with a Nocardia brain abscess.
Patient treated with trimethoprim-sulfamethoxazole and ceftriaxone for Nocardia abscess.
Monitored for symptoms including consciousness impairment and negative myoclonus.
Ceftriaxone was paused for assessment of its role in symptom development.
Negative myoclonus and consciousness impairment appeared during treatment.
Symptoms resolved quickly after discontinuing trimethoprim-sulfamethoxazole.
Ceftriaxone was deemed unlikely to be the cause based on symptom timing.

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Implication

Case report finds negative myoclonus as a symptom in a patient treated for Nocardia brain abscess, suggesting caution with TMP-SMX use.

Abstract

77歳男性．Nocardia abscessus脳膿瘍に対し，トリメトプリム・スルファメトキサゾール配合剤（trimethoprim-sulfamethoxazole，以下TMP-SMXと略記）とセフトリアキソン（ceftriaxone，以下CTRXと略記）による併用治療を行った．治療経過中に意識障害の増悪と四肢の陰性ミオクローヌスが出現した．臨床像はセファロスポリン系抗菌薬による脳症に類似したが，CTRX休薬期間中に症状が出現しており，CTRXや併用したカルバペネム系薬の関与は否定的であった．CTRX継続下でTMP-SMXのみを中止したところ，不随意運動および意識障害は速やかに消失した．腎機能正常例においては表現型のみで判断せず，高用量TMP-SMXによる脳症も鑑別に挙げるべきである．

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Cite This Study

Makino et al. (2026) studied this question.

synapsesocial.com/papers/69dc87ea3afacbeac03e9fab https://doi.org/10.5692/clinicalneurol.cn-002225

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Negative myoclonus associated with high-dose trimethoprim-sulfamethoxazole for treating Nocardia brain abscess

Key Points

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Negative myoclonus associated with high-dose trimethoprim-sulfamethoxazole for treating Nocardia brain abscess

Key Points

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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