Prolonged and recurrent hypoglycemia induced by trimethoprim-sulfamethoxazole in a Hodgkin lymphoma patient with Pneumocystis carinii pneumonia

Abstract

Positron emission tomography/computed tomography (PET/CT) revealed (i) enlarged lymph nodes that were widely distributed within the body with high fructose diphosphate (FDG) uptake, (ii) high FDG uptake in the L2 vertebra, right sacrum, sciatica, and femoral neck with local partial bone destruction, and (iii) low-density foci in the right lobe of the liver with increased glucose metabolism. [...]the patient was diagnosed as having classical Hodgkin lymphoma nodular sclerosis subtype, stage IV, group B. He was treated with the doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy regimen. Given that his estimated glomerular filtration rate was normal (70.97 mL·min−1·1.73 m−2), 1920 mg oral trimethoprim-sulfamethoxazole (TMP-SMX) was prescribed four times a day. Because his brain natriuretic peptide had increased, oral torsemide 10 mg/day was given. [...]an intravenous bolus of 50% dextrose was administered repeatedly every hour to maintain the appropriate plasma glucose level. Laboratory data during the hypoglycemia attack were as follows: plasma insulin was 115.3 μU/mL (reference range: 2.6–24.9 μU/mL), C-peptide was 19.55 ng/mL (reference range: 1.1–4.4 ng/mL), and morning cortisol and adrenocorticotropic hormone levels and thyroid function were normal. [...]TMP-SMX was suspected of causing the hypoglycemia.