Sudden Conjunctivitis, Lymphopenia, and Rash Combined With Hemodynamic Changes After Trimethoprim–Sulfamethoxazole Use

TAKE-HOME MESSAGE

• The authors of this retrospective case series propose an acronym, SCoRCH, for trimethoprim–sulfamethoxazole (TMP-SMX) severe hypersensitivity syndrome with clinical and mucocutaneous findings distinct from other drug reactions. They reviewed 7 cases in which patients treated with TMP-SMX developed the syndrome within 4 to 11 days in those with no prior TMP-SMX exposure and within 24 hours in those with prior exposure.
• Given the potential life-threatening presentation, clinicians should be aware of SCoRCH — sudden conjunctivitis, generalized erythema, lymphopenia, and hemodynamic instability — in a patient who used TMP-SMX in the preceding 2 weeks.

–  Ruth McTighe, MD

Abstract 

IMPORTANCE

Trimethoprim-sulfamethoxazole (TMP-SMX) hypersensitivity reaction, ranging from circulatory shock to aseptic meningitis and respiratory failure, is a potentially life-threatening condition with dermatologic relevance.

OBJECTIVE

To describe the mucocutaneous findings and clinical features of TMP-SMX hypersensitivity reaction.

DESIGN, SETTING, AND PARTICIPANTS

This was a retrospective case series study of 7 patients who developed a characteristic rash, hemodynamic changes, and end-organ dysfunction after treatment with TMP-SMX at a large university hospital system during January 2013 to March 2022.

EXPOSURES

Treatment with TMP-SMX within 2 weeks of the reaction.

MAIN OUTCOME AND MEASURES

Descriptions of the condition, including the demographic information of the affected population, the reaction timeline, and mucocutaneous and clinical features.

RESULTS

The cohort comprised 7 patients (median [range] age, 20 [15-66] years; 4 female and 3 male). The most common mucocutaneous findings were generalized sunburn-like erythema without scale, conjunctivitis, and mild facial and acral edema. Three patients had previous exposure to TMP-SMX and developed symptoms in 1 day or less, while those without prior exposure presented from 4 to 11 days after drug initiation. Among the 7 patients, 6 had fever, 7 had hypotension, and 7 had tachycardia. All patients had lymphopenia and evidence of end-organ dysfunction with either kidney or liver involvement. Median (range) time to resolution was 72 (48-96) hours.

CONCLUSIONS AND RELEVANCE

This retrospective case series indicates that SCoRCH (sudden conjunctivitis, lymphopenia, and rash combined with hemodynamic changes) should be considered in the differential diagnosis of patients presenting with acute generalized sunburn-like erythema, conjunctivitis, systemic symptoms, and hemodynamic changes in the setting of recent TMP-SMX use.

JAMA Dermatology

Sudden Conjunctivitis, Lymphopenia, and Rash Combined With Hemodynamic Changes (SCoRCH) After Trimethoprim-Sulfamethoxazole Use: A Case Series Study of a Hypersensitivity Reaction

JAMA Dermatol 2022 Nov 09;[EPub Ahead of Print], M O'Brian, EK Rose, MM Mauskar, AR Dominguez 

Sent from my iPhone

Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

Please excuse the shortness of this message, as it has been sent from
a mobile device.