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Adverse reactions frequently occur in patients with AIDS who are treated with trimethoprim-sulfamethoxazole (TMP/SMX) for Pneumocystis carinii pneumonia (PCP). Intolerance to sulfonamides is 10 times more common in HIV-infected patients than in the general population. [1] Dermatologic (rash, urticaria), gastrointestinal (nausea, vomiting, anorexia), and hematologic (leukopenia) side effects are most common. However, numerous adverse neurologic effects can occur, including headache, aseptic meningitis, ataxia, peripheral neuritis, seizures, hallucinations, and tremor. [2] All are potentially reversible with cessation of TMP/SMX or, in some cases, with only a dose reduction. I report a patient with AIDS treated with TMP/SMX for PCP who developed a marked postural and kinetic tremor without other stigmata of TMP/SMX-induced reactions, which resolved with its discontinuation.
Case report.
A 46-year-old man with a 6-year history of AIDS was evaluated for "shakes." He was on day 13 of TMP/SMX treatment (320 mg of trimethoprim and 1,600 mg of sulfamethoxazole three times daily) for PCP and had experienced increasing tremulousness over the preceding 10 days. His other medications included paroxetine, didanosine (ddI), prednisone, leucovorin, clotrimazole, and diazepam, none of which had been started recently. The tremor involved his head and all extremities, and he had noticed a precipitous …
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