Hepatic Necrosis and Trimethoprim-Sulfamethoxazole

To the Editor.— Trimethoprim-sulfamethoxazole (Bactrim) has been reported as a cause of jaundice.1While sulfamethoxazole can, rarely, cause hepatic lesions,2-7there is no information on the effect of trimethoprim. Report of a Case.— An 80-year-old man had arteriosclerotic heart disease and varicose veins with leg edema. Five months after admission to the hospital, bilateral orchitis developed. Trimethoprim (4 mg/ kg)-sulfamethoxazole (20 mg/kg) was added to the established therapy (digoxin and aminophylline orally and local treatment). Orchitis regressed in ten days and trimethoprim-sulfamethoxazole therapy was suspended. Ten days later, however, jaundice and hepatomegaly appeared. There was a moderate quantity of protein, bilirubin, and urobilinogen in the urine. Total serum bilirubin level was 10 mg/100 ml, and serum glutamic (SGOT) and pyruvic (SGPT) transaminase levels were 200 and 135 milliunits (mU)/ml, respectively. Other values were as follows: serum alkaline phosphatase, 245 mU/ml; blood urea nitrogen, 34 mg/100 ml; fasting blood