T. Hofer, E. W. Becker, K. Weigand and P. A. Berg, “Demonstration of Sensitized Lymphocytes to Trime- Thoprim/Sulfamethoxazole and Ofloxacin in a Patient with Cholestatic Hepatitis,” Journal of Hepatology, Vol. 15, No. 1-2, 1992, pp. 262-263. doi:10.1016/0168-8278(92)90045-Q

has been cited by the following article:

• TITLE: Trimethoprim-Sulfamethoxazole-Induced Hepatitis in Mixed Connective Tissue Disease

  AUTHORS: Takeshi Sugimoto, Yumiko Nobuhara, Seiji Kawano, Akio Morinobu

  KEYWORDS: Hepatic toxicity, Mixed Connective Tissue Disease, N-Acetyltransferase 2, Trimethoprim-Sulfamethoxazole

  JOURNAL NAME: International Journal of Clinical Medicine, Vol.2 No.5, November 17, 2011

  ABSTRACT: Trimethoprim-Sulfamethoxazole (TMP-SMZ) is associated with severe hepatic toxicity or liver failure. We present a case of severe hepatic toxicity for whom TMP-SMZ was prescribed as part of treatment for mixed connective tissue disease (MCTD). TMP-SMZ was used to prevent complications from steroid therapy, but fever and hepatic toxicity developed with repeated TMP-SMZ medication. While the drug lymphocyte stimulation test (DLST) for TMP-SMZ showed negative, the genotype for N-acetyltransferase 2 (NAT2) showed type *6/*7, which is the slow acetylating type for NAT2 activity. This finding for NAT2 genotype and the patient’s clinical history lead us to speculate that her fever and hepatic toxicity were caused by TMP-SMZ.