Wegener granulomatosis and trimethoprim-sulfamethoxazole. Complete remission after a twenty-year course

Ann Intern Med. 1987 Jun;106(6):840-2. doi: 10.7326/0003-4819-106-6-840.

Abstract

Wegener granulomatosis was diagnosed in a 42-year-old woman in 1965. Although a regimen of azathioprine and prednisone was helpful, the disease progressed. Cyclophosphamide was added to this regimen in 1969. On three separate occasions her disease relapsed when cyclophosphamide therapy was discontinued. In 1984, she developed cyclophosphamide-resistant disease and drug toxicity. We were able to discontinue cyclophosphamide therapy after a trimethoprim-sulfamethoxazole regimen that was begun in February 1985 led to rapid improvement, a fall in the erythrocyte sedimentation rate, and a complete remission. Her 22-year survival is the longest one reported. Because patients with Wegener granulomatosis sometimes respond to trimethoprim-sulfamethoxazole, this therapy deserves careful study and implies that Wegener granulomatosis is an as yet unidentified infection.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Blood Sedimentation
  • Cyclophosphamide / therapeutic use
  • Drug Combinations / therapeutic use
  • Drug Therapy, Combination
  • Female
  • Granulomatosis with Polyangiitis / blood
  • Granulomatosis with Polyangiitis / drug therapy*
  • Hematuria / drug therapy
  • Hemoglobins / metabolism
  • Humans
  • Leukocyte Count / drug effects
  • Middle Aged
  • Sulfamethoxazole / therapeutic use*
  • Trimethoprim / therapeutic use*
  • Trimethoprim, Sulfamethoxazole Drug Combination

Substances

  • Drug Combinations
  • Hemoglobins
  • Trimethoprim, Sulfamethoxazole Drug Combination
  • Cyclophosphamide
  • Trimethoprim
  • Sulfamethoxazole