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Background: Sulfamethoxazole-trimethoprim is an antibiotic that can cause rare and potentially life-threatening adverse effects. This case describes an immunocompetent patient who developed acute agranulocytosis complicated with aseptic meningitis after being prescribed sulfamethoxazole-trimethoprim.
Case Presentation: A healthy 39-year-old male veteran presented to the emergency department with worsening left testicular pain and increased urinary urgency and frequency. The patient was diagnosed with left epididymo-orchitis and prescribed oral sulfamethoxazole-trimethoprim 800-160 mg every 12 hours for 30 days. Two weeks later, the patient returned to the emergency department with fever, headache, chills, and generalized body aches that led to hospitalization. It was discovered that he had not finished the full course of antibiotics due to symptoms resolution and had restarted the medication to finish the course of therapy. The patient was diagnosed with agranulocytosis and aseptic meningitis secondary to sulfamethoxazole-trimethoprim.
Conclusions: This case highlights the rare potential for acute agranulocytosis in combination with aseptic meningitis following the use of sulfamethoxazole-trimethoprim in an immunocompetent patient.
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http://dx.doi.org/10.12788/fp.0527 | DOI Listing |
Cureus
August 2025
Graduate Medical Education, University of Pittsburgh Medical Center, Altoona, USA.
Varicella zoster virus (VZV) is a single-stranded enveloped RNA virus that is a common cause of chickenpox and herpes zoster. Herpes zoster (shingles) presents with a painful rash in a dermatomal distribution. Ramsay-Hunt syndrome (herpes zoster oticus) is a specific form of shingles, which occurs due to viral reactivation in the geniculate ganglion of cranial nerve VII.
View Article and Find Full Text PDFFront Oncol
August 2025
Division of Oncology, Washington University in St. Louis, St. Louis, MO, United States.
Background: Predicting the occurrence of immune-related adverse events (irAEs) related to immune checkpoint inhibitors (ICI) is complex. Monitoring of irAEs is critical as toxicities cause morbidity and impact quality of life. Thus, we systematically evaluated the patterns and consistency of irAEs reporting in trials leading to US Food and Drug Administration (FDA) ICI approvals.
View Article and Find Full Text PDFPathogens
August 2025
Department of Pediatrics and Developmental Biology, Institute of Science Tokyo, 1-5-45 Bunkyo-ku, Tokyo 113-8519, Japan.
The varicella attenuated virus vaccine, developed in Japan in the 1970s, has dramatically reduced the number of pediatric chickenpox cases over the past 30 years due to its widespread use. However, a small number of cases of chickenpox, shingles, aseptic meningitis, and acute retinal necrosis caused by vaccine strains have been reported. There are also issues that need to be addressed, such as breakthrough infections and the persistence of the preventive effect of vaccination.
View Article and Find Full Text PDFFront Med (Lausanne)
August 2025
Department of Neurology, Puer People's Hospital, Pu'er, China.
Background: Varicella zoster virus (VZV) infection during pregnancy can lead to severe complications. However, cases complicated by aseptic meningitis in early pregnancy (<20 weeks) are extremely rare, and clinical management and pregnancy outcomes remain unclear.
Case Report: We report a case of a 36-year-old pregnant woman who developed right upper abdominal pain, headache, and cough at 17 weeks of gestation, followed by clustered herpes zoster lesions in the right lumbar region and signs of meningeal irritation.
Emerg Microbes Infect
December 2025
University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
Lymphocytic choriomeningitis virus (LCMV) is an underreported emerging pathogen and was recently included as a National Institute of Allergy and Infectious Disease (NIAID) priority pathogen. LCMV is an important cause of aseptic meningitis and has high morbidity and mortality during congenital and organ-transplant transmission. The house mouse, , is a reservoir for LCMV, and human infection occurs through exposure to aerosolized virus from the mouse excreta.
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