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Acute Megaloblastic Anemia Induced by High-Dose Trimethoprim-Sulfamethoxazole

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Supported in part by Hematology Training Grant 2T32-HL07145-06A1 and grants CA 19527 and CA 21737 from the U.S. Department of Health and Human Services.

▸Requests for reprints should be addressed to Nathan L. Kobrinsky, M.D.; Box 239 Mayo, 420 Delaware Street SE; Minneapolis, MN 55455.

University of Minnesota; Minneapolis, Minnesota

Ann Intern Med. 1981;94(6):780-781. doi:10.7326/0003-4819-94-6-780
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Trimethoprim-sulfamethoxazole is used in a wide range of bacterial infections and is the preferred treatment for pneumocystis pneumonia. Despite the theoretical potential for inducing an acute megaloblastic state by synergistic inhibition of tetrahydrofolate synthesis, hematologic toxicities are rarely described after oral administration because of specificity for bacterial and protozoan systems (1). The development of pancytopenia after treatment with high-dose trimethoprim-sulfamethoxazole (20 and 100 mg/kg of body weight) in a patient with low folate stores illustrates the importance of recognizing high-risk situations in preventing toxicity from this drug.

A 22-year-old white woman was admitted to the University of Minnesota Hospitals because


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