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The Drug-Induced Respiratory Disease Website and App

Trimethoprim sulfamethoxazole (TMP-SMX)

Specialities: Diagnostic radiology · Infectious diseases · Intensive care medicine · Internal medicine · Orthopedic surgery · Pathology · Pulmonary medicine

An antibiotic widely use to prevent Pneumocystis pneumonia from developing. The drug is also used to treat acne in young persons. The major adverse effect is an ARDS picture leading to life-threatening poorly reversible lung damage requiring lung transplantation in a sizeable fraction of the patients.

Frequency - Incidence

Incidence of respiratory adverse event(s) due to the specific drug as assessed by number of reported/published cases in the literature. Red digits in stars indicate: 0 = Very rare, questionable signal · 1 = < 10 cases · 2 = 10-50 cases · 3 = 50–100 cases · 4 = 100-200 cases · 5 = >200 cases

Evidence level/grade

Evidence level for respiratory adverse event(s) due to the specific drug as estimated using Hill’s (1965), Naranjo’s (1981), and Bégaud’s (1985) criteria applied to published cases. Blue digits in stars indicate: 0 = Questionable · 1 = Low · 2 = Moderate · 3 = Robust · 4 = Definite · 5 = Unquestionable, pathognomonic

I - Interstitial/parenchymal lung disease

I.a

Pneumonitis (ILD), acute and/or severe (may produce the ARDS pattern)
I.b

Pneumonitis (interstitial lung disease/ILD)
I.c

Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia)
I.e

Acute eosinophilic pneumonia (AEP)
I.f

Acute fibrinous organizing pneumonia (AFOP)
I.ba

Irreversible respiratory damage requiring lung Tx

II - Pulmonary edema - Acute lung injury - ARDS

II.a

Pulmonary edema, noncardiogenic (NCPE)
II.b

ARDS - Acute lung injury
II.t

Acute respiratory failure (e.g. from ARDS, ILD, PIE, OP, pulmonary edema or bronchospasm) requiring ECMO

V - Pleural and/or pericardial involvement

V.f

Pneumothorax

VII - Mediastinal involvement

VII.h

Pneumomediastinum

X - Systemic/Distant conditions, syndromes and reactions

X.a

DRES syndrome - DRESS-like reaction
X.e

Autoimmunity-Autoimmune conditions (+ANA, +anti-ds-DNA, +ANCAs, other auto-Abs)
X.f

Anaphylaxis-Anaphylactoid reaction (can be fatal)
X.g

Hypersensitivity reaction (may manifest with fever and/or skin, throat or airway involvement)
X.x

ANCA positivity. Subclinical or with clinical manifestations

XIV - Hemoglobinopathies - Abnormal hemoglobin states (acquired)

XIV.a

Methemoglobinemia

XV - Pathology

XV.a

Path: NSIP-cellular pattern (see also Ia, Ib)
XV.b

Path: Eosinophilic pneumonia (subacute or acute) (see also Ic)
XV.f

Path: Diffuse alveolar damage (DAD-pattern) (see also IL)
XV.h

Path: NSIP-fibrotic pattern
XV.bl

Path: Resolving alveolar damage
XV.ct

Path: Delayed Alveolar Injury with Delayed Epithelialization (DAIDE)

XVI - Imaging

XVI.f

Imaging: Bibasilar opacities/shadowing
XVI.bb

Imaging: Pneumomediastinum

XIX - Cytological, biochemical features of/in BAL, pleural fluid or FNA

XIX.a

BAL: An excess proportion of lymphocytes
XIX.c

BAL: An excess proportion of eosinophils