A rare case of Cotrimoxazole induced acute pancreatitis, acute kidney injury and crystalluria (APAKIC)

Cotrimoxazole (TMP/SMX) is the drug of choice for treating Pneumocystis Jeroveci pneumonia (PJP) in retroviral infections. Incidence of Co-trimoxazole causing pancreatitis and kidney injury being extremely rare, adverse drug reaction (ADR) monitoring is warranted. A 50 year old female newly diagnosed patient with HIV1 positive was treated with TMP/SMX for pneumocystis pneumonia. A total of 3 tablets each containing 800mg sulfamethoxazole and 160 mg trimethoprim thrice daily for 24 days along with intravenous injection once daily for 6 days was given. Three adverse drug reports were reported. Rise in serum amylase/lipase suggesting acute pancreatitis and rise in urea, creatinine and electrolytes suggesting acute kidney injury was observed along with crystalluria. As a part of intervention the drug was stopped, 5% dextrose along with sodium bicarbonate were given. Kidney injury and crystalluria resolved, pancreatitis is still resolving. All ADRs were classified as probable according to Naranjo scale, moderately severe according to Hartwig's scale. The kidney injury is preventable and acute pancreatitis and crystalluria are not preventable according to Schumock and Thornton scale. This case demonstrates a causal relationship between TMP/SMX and above mentioned adverse events. Hence, it is prudent enough to exercise caution when using Cotrimoxazole.