{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:03:39Z","timestamp":1756339419618,"version":"3.44.0"},"reference-count":6,"publisher":"BMJ","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ Case Reports"],"abstract":"<jats:p>Here we present a case of refractory hypoglycaemia associated with use of the antibiotic trimethoprim-sulfamethoxazole (TMP-SMX). This was used to treat <jats:italic>Pneumocystis jirovecii<\/jats:italic> pneumonia (PCP) infection. The patient had significant pre-existing renal impairment with a kidney transplant in situ. Refractory hypoglycaemia occurred 5\u2005days after starting the antibiotic and persisted for 36\u2005h after its cessation. SMX contains the same sulphanilamide structural group as the oral hypoglycaemic agents called sulphonureas. SMX could therefore act as an insulin secretagogue. The inappropriately raised insulin and c-peptide levels seen in our patient support this theory. The 5-day asymptomatic period would allow sufficient time for the drug to accumulate and the extended period seen after its cessation would be seen in a dose-dependent side effect. Following 3\u2005days of observation and continuous glycaemic support on the High Dependency Unit she was discharged back to the ward, with no further occurrence of hypoglycaemia.<\/jats:p>","DOI":"10.1136\/bcr-2012-007215","type":"journal-article","created":{"date-parts":[[2012,11,9]],"date-time":"2012-11-09T11:44:01Z","timestamp":1352461441000},"page":"bcr2012007215","source":"Crossref","is-referenced-by-count":4,"title":["Hypoglycaemia associated with co-trimoxazole use in a 56-year-old Caucasian woman with renal impairment"],"prefix":"10.1136","volume":"2012","author":[{"given":"Donall G","family":"Forde","sequence":"first","affiliation":[{"name":"Department of Infection and Tropical Medicine, Sheffield Teaching Hospital, Sheffield, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jody","family":"Aberdein","sequence":"additional","affiliation":[{"name":"Department of Infection and Tropical Medicine, Sheffield Teaching Hospital, Sheffield, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne","family":"Tunbridge","sequence":"additional","affiliation":[{"name":"Department of Infection and Tropical Medicine, Sheffield Teaching Hospital, Sheffield, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ben","family":"Stone","sequence":"additional","affiliation":[{"name":"Department of Infection and Tropical Medicine, Sheffield Teaching Hospital, Sheffield, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2012,11,9]]},"reference":[{"doi-asserted-by":"publisher","key":"2025082702190961000_2012.nov07_1.bcr2012007215.1","DOI":"10.1016\/S1473-3099(06)70414-5"},{"key":"2025082702190961000_2012.nov07_1.bcr2012007215.2","first-page":"646","article-title":"Clinical use of trimethoprim\/sulfamethoxazole during renal dysfunction","volume":"23","author":"Paap","year":"1989","journal-title":"Drug Intell Clin Pharm"},{"doi-asserted-by":"publisher","key":"2025082702190961000_2012.nov07_1.bcr2012007215.3","DOI":"10.2337\/diacare.7.5.508"},{"key":"2025082702190961000_2012.nov07_1.bcr2012007215.4","first-page":"250","article-title":"Symptomatic hypoglycemia secondary to a glipizide-trimethoprim\/sulfamethoxazole drug interaction","volume":"24","author":"Dobmeier","year":"1990","journal-title":"Ann Pharmacother"},{"key":"2025082702190961000_2012.nov07_1.bcr2012007215.5","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1177\/106002809302700309","article-title":"Hypoglycemia secondary to trimethoprim\/sulfamethoxazole administration in a renal transplant patient","volume":"27","author":"Johnson","year":"1993","journal-title":"Ann Pharmacother"},{"doi-asserted-by":"crossref","unstructured":"Alanio A, Desoubeaux G, Sarfati C, et al. Real-time PCR assay-based strategy for differentiation between active Pneumocystis jirovecii pneumonia and colonization in immunocompromised patients. Clin Microbiol Infect 2011; 17(10):1531\u20137.","key":"2025082702190961000_2012.nov07_1.bcr2012007215.6","DOI":"10.1111\/j.1469-0691.2010.03400.x"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2012-007215","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T09:19:20Z","timestamp":1756286360000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2012-007215"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2012,11,9]]},"references-count":6,"alternative-id":["10.1136\/bcr-2012-007215"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2012-007215","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2012,11,9]]}}}