100% N4-acetyl-sulfamethoxazole stone induced by Trimethoprim-Sulfamethoxazole in an HIV patient being treated for toxoplasmosis

• DOI: 10.1016/j.eucr.2020.101453
• Publication Date: 2020-10-17T15:34:34Z
• Authors: Matthew S. DeMasi; Ari P. Bernstein; Michael Schulster; Mark V. Silva
• Keywords: Sulfamethoxazole; Trimethoprim; Toxoplasmosis; AIDS-Related Opportunistic Infections

Trimethoprim-Sulfamethoxazole is a common antibiotic used to treat urinary tract infections, as well prophylactic agent in HIV patients with low CD4 counts. Exceedingly rare are stones consisting purely of its metabolite, N4-acetyl-sulfamethoxazole, and management strategies not documented the literature. We present case patient who was found have obstructing ureteral calculi composed 100% N4-acetyl-sulfamethoxazole. Our report contributes unique Bactrim-induced stone an immunocompromised patient. Similar can be prophylactically treated diuresis alkalinization, consideration for alternative medication use.