Severe and long lasting cholestasis after high-dose co-trimoxazole treatment for Pneumocystis pneumonia in HIV-infected patients--a report of two cases

Int J Infect Dis. 2009 Nov;13(6):e467-9. doi: 10.1016/j.ijid.2008.12.016. Epub 2009 Mar 18.


Pneumocystis pneumonia (PCP), a common opportunistic infection in HIV-infected individuals, is generally treated with high doses of co-trimoxazole. However, treatment is often limited by adverse effects. Here, we report two cases of severely immunocompromised HIV-infected patients who developed severe intrahepatic cholestasis, and in one patient lesions mimicking liver abscess formation on radiologic exams, during co-trimoxazole treatment for PCP. Whereas patient 1 showed lesions of up to 1 cm readily detectable on magnetic resonance imaging under prolonged co-trimoxazole treatment, therapy of patient 2 was switched early.

Publication types

  • Case Reports

MeSH terms

  • AIDS-Related Opportunistic Infections / drug therapy*
  • AIDS-Related Opportunistic Infections / microbiology
  • Adult
  • Anti-Infective Agents / administration & dosage
  • Anti-Infective Agents / adverse effects*
  • Anti-Infective Agents / therapeutic use
  • Cholestasis, Intrahepatic / chemically induced*
  • Cholestasis, Intrahepatic / pathology
  • Cholestasis, Intrahepatic / physiopathology
  • Humans
  • Immunocompromised Host
  • Magnetic Resonance Imaging
  • Male
  • Pneumocystis carinii* / drug effects
  • Pneumonia, Pneumocystis / drug therapy*
  • Pneumonia, Pneumocystis / microbiology
  • Trimethoprim, Sulfamethoxazole Drug Combination / administration & dosage
  • Trimethoprim, Sulfamethoxazole Drug Combination / adverse effects*
  • Trimethoprim, Sulfamethoxazole Drug Combination / therapeutic use
  • Young Adult


  • Anti-Infective Agents
  • Trimethoprim, Sulfamethoxazole Drug Combination