Single-strength trimethoprim/sulfamethoxazole (TMP/SMX)-induced hypoglycaemia in a post kidney-pancreas transplant patient
Year: 2026
Type: article
Study design: Case Report
Abstract: Single-strength trimethoprim/sulfamethoxazole (TMP/SMX) is standard prophylaxis against Pneumocystis jirovecii pneumonia in solid organ transplant recipients but hypoglycaemia at this prophylactic dose is rare. We report severe recurrent hypoglycaemia after TMP/SMX rechallenge in a man in his 30s who underwent simultaneous kidney-pancreas transplantation. TMP/SMX was withheld because of hyperkalaemia and temporarily replaced with nebulised pentamidine; after the hyperkalaemia resolved, single-strength TMP/SMX (trimethoprim 80 mg/sulfamethoxazole 400 mg once a day) was restarted, at which point renal allograft function and tacrolimus exposure were both stable. Four days later, the patient developed weakness and dizziness with home glucose readings of 28, 33 and 36 mg/dL on consecutive days. Symptoms resolved after drug withdrawal. A Naranjo score of 5 supported a probable TMP/SMX-associated adverse drug reaction, although the absence of paired biochemical testing during the episodes limits definitive mechanistic attribution.
Source: BMJ Case Reports
Institution: Medical City Dallas Hospital
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7224087774