Hi my name is faisa emmet and i am an internal medicine resident at dmc sinai grace hospital my case today addresses the routine use of bactrim for the treatment of urinary tract infections in the outpatient setting systemic lupus erythematosus is an autoimmune condition that is well known to be the great systemic lupus erythematosus is an autoimmune condition
That is well known to be the great mimicker of modern times one of the more severe and disease altering associations for sle is the kidney damage that comes along with it there are various types of kidney damage associated with lupus based off of histopathology but all of them lead to impaired renal function due to immune mediated damage to the renal architecture
Lupus nephritis itself is independently associated with end-stage renal disease and increased mortality flares of lupus with renal involvement increase the chances of progression to further kidney damage and ending up with dialysis dependence this case is of one such patient an 18 year old female with known history of sle and biopsy diagnosed class 3 and class 5
Lupus nephritis who presented to the emergency department with complaints of increased urinary frequency and a urinalysis suspicion for of an infection with elevated urinary white cell count and four plus bacteriuria she was stabilized in the ed and prescribed a five-day course of trimethoprim sulfamethoxazole commonly known as bactrim within four days she came
Back to the ed with complaints of pleuritic chest pain photophobia shortness of breath diarrhea and pain in her back bilateral elbows bilateral wrists and left ankle initial vitals showed a blood pressure of 90 over 56 millimeters of mercury heart rate of 118 beats per minute respiratory rate of 24 breaths per minute temperature of 38.6 degrees centigrade and
Saturation of 98 on room air her lab values were significant for an elevation in creatinine of greater than 0.3 grams per deciliter indicating an acute kidney injury a small decrease in hemoglobin along with schistocytes on peripheral smear her urinalysis however showed a decrease in white cell count as well as a decrease in bacteria indicating some amount of
Response to the treatment she continued to have high levels of proteinuria along with hyaline cast in the urine her c3 was 56 and c4 was 9 indicating that some consumption was ongoing along with an elevated a a titer at 1 is to 1280. she was initially given steroids and iv fluids which helped to resolve her symptoms and restarted on the hydroxychloroquine and
Mycophenolate mofotel that she was supposed to be on however within the next five months she had another three hospitalizations with similar complaints with the result that she became dialysis dependent at the end of this time sulfa drugs are a common source of drug allergies bactrim itself is generally well tolerated and and an effective medication for urinary
Tract infections especially in the general population certain groups however warrant greater caution each sle flare worsens the disease prognosis and hasn’t the journey towards end-stage organ damage in patients such as this one already on the road to ruin with non-compliance to essential treatment it becomes even more important to follow the hippocratic principle
Of do no harm each successfully prevented flare is an unrecognized victory in this disease bactrim unfortunately served to push this patient further along the road to becoming dialysis dependent at the tender age of 18 years
Transcribed from video
Trimethoprim-Sulfamethoxazole: Lighting a Fire in Lupus Nephritis By Dr. Ahmed
