Contributing factors in trimethoprim-sulfamethoxazoleinduced tremor in Pneumocystis jirovecii pneumonia

Trimethoprim-sulfamethoxazole (TMP-SMX) is the first-line antibiotic for the treatment of opportunistic infections, including Pneumocystis jirovecii pneumonia (PJP), in immunocompromised patients. [1,2]Most patients tolerate the treatment well, particularly in lower doses, but dose-related dermatological, renal, and hepatic reactions are the most common adverse events (AEs). [1,2]lthough neurological AEs are rare, TMP-SMXinduced tremor has been infrequently reported since 1988 as a reversible neurotoxic AE at higher doses, mostly in immunocompromised patients. [3][4][5][6] Herein, we presented a patient with tremor induced by both mild hypoxia and TMP-SMX during PJP treatment.