Bactrim-Induced Hepatotoxicity

Sulfamethoxazole/trimethoprim (SMX/TMP) is a commonly used antimicrobial agent for treating common bacterial infections such as urinary tract infection (UTI), combined with doxycycline for community-acquired methicillin-resistant <i>Staphylococcus aureus</i> (MRSA), and invaluable in <i>Pneumocystis jirovecii</i> pneumonia (PJP), previously classified as <i>Pneumocystis carinii</i>. Of its known adverse reactions, hepatotoxicity rarely comes to mind, but indeed, it is a recognized but very rare adverse reaction that may lead to liver failure in adults and even rarer in children. We present a case of hepatotoxicity in a 43-year-old male patient on no prior medication who developed jaundice and highly elevated liver enzymes one week after the administration of Bactrim for the treatment of UTI in association with prostatism, symptoms of decreased urinary force due to obstruction of flow through the prostate gland. He made a good recovery over several weeks with discontinuation of the medication and supportive care.