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Wegener Granulomatosis and Trimethoprim-Sulfamethoxazole: Complete Remission After a Twenty-Year Course

BURTON C. WEST, M.D.; JOHN R. TODD, M.D.; and JOHN W. KING, M.D.
[+] Article and Author Information

Grant support: in part by the Edward P. Stiles and the First Family Foundations.

▸Requests for reprints should be addressed to Burton C. West, M.D.; Section of Infectious Diseases, Department of Medicine, LSU Medical Center, P.O. Box 33932; Shreveport, LA 71130-3932.


Shreveport, Louisiana


© 1987 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1987;106(6):840-842. doi:10.7326/0003-4819-106-6-840
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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.

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