{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T02:23:17Z","timestamp":1785291797877,"version":"3.55.0"},"reference-count":15,"publisher":"American Medical Association (AMA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Dermatol"],"published-print":{"date-parts":[[2023,1,1]]},"abstract":"Importance<\/jats:title>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.<\/jats:p><\/jats:sec>Objective<\/jats:title>To describe the mucocutaneous findings and clinical features of TMP-SMX hypersensitivity reaction.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>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.<\/jats:p><\/jats:sec>Exposures<\/jats:title>Treatment with TMP-SMX within 2 weeks of the reaction.<\/jats:p><\/jats:sec>Main Outcome and Measures<\/jats:title>Descriptions of the condition, including the demographic information of the affected population, the reaction timeline, and mucocutaneous and clinical features.<\/jats:p><\/jats:sec>Results<\/jats:title>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.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>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.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamadermatol.2022.4657","type":"journal-article","created":{"date-parts":[[2022,11,9]],"date-time":"2022-11-09T16:01:59Z","timestamp":1668009719000},"page":"73","source":"Crossref","is-referenced-by-count":8,"title":["Sudden Conjunctivitis, Lymphopenia, and Rash Combined With Hemodynamic Changes (SCoRCH) After Trimethoprim-Sulfamethoxazole Use"],"prefix":"10.1001","volume":"159","author":[{"given":"Madeleine","family":"O\u2019Brian","sequence":"first","affiliation":[{"name":"University of Texas Southwestern Medical School, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elysha K.","family":"Rose","sequence":"additional","affiliation":[{"name":"University of Texas Southwestern Medical School, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa M.","family":"Mauskar","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University of Texas Southwestern Medical Center, Dallas"},{"name":"Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arturo R.","family":"Dominguez","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University of Texas Southwestern Medical Center, Dallas"},{"name":"Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"1","key":"dbr220021r1","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1186\/s40360-018-0269-3","article-title":"Trimethoprim-sulfamethoxazole induced circulatory shock in a human immunodeficiency virus uninfected patient: a case report and review.","volume":"19","author":"Liu","year":"2018","journal-title":"BMC Pharmacol Toxicol"},{"issue":"3","key":"dbr220021r2","doi-asserted-by":"publisher","first-page":"382","DOI":"10.1093\/jpids\/piaa100","article-title":"Atypical severe shock-like reactions in adolescents after trimethoprim-sulfamethoxazole therapy.","volume":"10","author":"Rathe","year":"2021","journal-title":"J Pediatric Infect Dis Soc"},{"issue":"5","key":"dbr220021r3","doi-asserted-by":"publisher","first-page":"520","DOI":"10.1016\/j.anai.2014.08.006","article-title":"Trimethoprim-sulfamethoxazole-induced aseptic meningitis-not just another sulfa allergy.","volume":"113","author":"Bruner","year":"2014","journal-title":"Ann Allergy Asthma Immunol"},{"issue":"6","key":"dbr220021r4","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1002\/j.1875-9114.1990.tb03574.x","article-title":"Trimethoprim-sulfamethoxazole anaphylactoid reactions in patients with AIDS: case reports and literature review.","volume":"10","author":"Johnson","year":"1990","journal-title":"Pharmacotherapy"},{"issue":"1","key":"dbr220021r5","first-page":"67","article-title":"Suspected case of drug-induced acute respiratory distress syndrome following trimethoprim-sulfamethoxazole treatment.","volume":"11","author":"Natterer","year":"2020","journal-title":"J Pediatr Intensive Care"},{"issue":"5","key":"dbr220021r6","doi-asserted-by":"publisher","first-page":"885","DOI":"10.1093\/clinids\/17.5.885","article-title":"A case of hyperdynamic shock caused by trimethoprim-sulfamethoxazole in which no tumor necrosis factor or features of anaphylaxis were detected.","volume":"17","author":"Nguyen","year":"1993","journal-title":"Clin Infect Dis"},{"issue":"9","key":"dbr220021r7","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2020-235803","article-title":"Case of relapsing sulfasalazine-induced hypersensitivity syndrome upon re-exposure.","volume":"13","author":"Winward","year":"2020","journal-title":"BMJ Case Rep"},{"issue":"8","key":"dbr220021r8","doi-asserted-by":"publisher","first-page":"1137","DOI":"10.1086\/cid.2002.34.issue-8","article-title":"Abacavir hypersensitivity reaction.","volume":"34","author":"Hewitt","year":"2002","journal-title":"Clin Infect Dis"},{"issue":"1","key":"dbr220021r9","first-page":"171","article-title":"Severe systemic hypersensitivity reaction to ibuprofen: a presentation of systemic lupus erythematosus.","volume":"33","author":"Mou","year":"2006","journal-title":"J Rheumatol"},{"issue":"1","key":"dbr220021r10","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1016\/j.jaad.2010.04.041","article-title":"The cutaneous and systemic manifestations of azathioprine hypersensitivity syndrome.","volume":"65","author":"Bidinger","year":"2011","journal-title":"J Am Acad Dermatol"},{"issue":"4","key":"dbr220021r11","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1097\/01.md.0000229757.78057.50","article-title":"Characteristics of meningitis caused by Ibuprofen: report of 2 cases with recurrent episodes and review of the literature.","volume":"85","author":"Rodr\u00edguez","year":"2006","journal-title":"Medicine (Baltimore)"},{"issue":"5","key":"dbr220021r12","doi-asserted-by":"publisher","first-page":"1076","DOI":"10.1046\/j.1365-2133.2003.05274.x","article-title":"Azathioprine hypersensitivity in a patient with peripheral demyelinating polyneuropathy.","volume":"148","author":"Hinrichs","year":"2003","journal-title":"Br J Dermatol"},{"issue":"10106","key":"dbr220021r13","doi-asserted-by":"publisher","first-page":"1996","DOI":"10.1016\/S0140-6736(16)30378-6","article-title":"Severe cutaneous adverse reactions to drugs.","volume":"390","author":"Duong","year":"2017","journal-title":"Lancet"},{"key":"dbr220021r14","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1016\/j.jdcr.2022.02.009","article-title":"Acute generalized exanthematous pustulosis sine pustules: a case series.","volume":"23","author":"Svoboda","year":"2022","journal-title":"JAAD Case Rep"},{"issue":"4","key":"dbr220021r15","doi-asserted-by":"publisher","DOI":"10.1002\/ski.v1.4","article-title":"Clinical characteristics and management of acute generalized exanthematous pustulosis with haemodynamic instability.","volume":"1","author":"O\u2019Brian","year":"2021","journal-title":"Skin Health Dis"}],"container-title":["JAMA Dermatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamadermatology\/articlepdf\/2798021\/jamadermatology_obrian_2022_br_220021_1673370634.05482.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,30]],"date-time":"2023-11-30T14:23:14Z","timestamp":1701354194000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamadermatology\/fullarticle\/2798021"}},"subtitle":["A Case Series Study of a Hypersensitivity Reaction"],"short-title":[],"issued":{"date-parts":[[2023,1,1]]},"references-count":15,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2023,1,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamadermatol.2022.4657","relation":{},"ISSN":["2168-6068"],"issn-type":[{"value":"2168-6068","type":"print"}],"subject":[],"published":{"date-parts":[[2023,1,1]]}}}