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Peer-reviewedCC BY-NC 4.0BMJ Case Reports

Single-strength trimethoprim/sulfamethoxazole (TMP/SMX)-induced hypoglycaemia in a post kidney-pancreas transplant patient

  • Naseeruddin Khan1
  • Numair Khan2
  • Irfan Agha3
  • Sareena Contractor3
  1. 1Transplant, Medical City Healthcare, Dallas, Texas, USA
  2. 2Research, Medical City Dallas Hospital, Dallas, Texas, USA
  3. 3Medical City Dallas Hospital, Dallas, Texas, USA
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Abstract

Single-strength trimethoprim/sulfamethoxazole (TMP/SMX) is standard prophylaxis against Pneumocystis jirovecii pneumonia in solid organ transplant recipients but hypoglycaemia at this prophylactic dose is rare. We report severe recurrent hypoglycaemia after TMP/SMX rechallenge in a man in his 30s who underwent simultaneous kidney-pancreas transplantation. TMP/SMX was withheld because of hyperkalaemia and temporarily replaced with nebulised pentamidine; after the hyperkalaemia resolved, single-strength TMP/SMX (trimethoprim 80 mg/sulfamethoxazole 400 mg once a day) was restarted, at which point renal allograft function and tacrolimus exposure were both stable. Four days later, the patient developed weakness and dizziness with home glucose readings of 28, 33 and 36 mg/dL on consecutive days. Symptoms resolved after drug withdrawal. A Naranjo score of 5 supported a probable TMP/SMX-associated adverse drug reaction, although the absence of paired biochemical testing during the episodes limits definitive mechanistic attribution.

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Cite

BibTeXRIS
BibTeX
@article{khan2026singlestrength,
  title = {{Single-strength trimethoprim/sulfamethoxazole (TMP/SMX)-induced hypoglycaemia in a post kidney-pancreas transplant patient}},
  author = {Naseeruddin Khan and Numair Khan and Irfan Agha and Sareena Contractor},
  journal = {BMJ Case Reports},
  year = {2026},
  month = oct,
  doi = {10.1136/bcr-2026-275639},
  url = {https://doi.org/10.1136/bcr-2026-275639},
  note = {CC BY-NC 4.0},
}
RIS
TY  - JOUR
TI  - Single-strength trimethoprim/sulfamethoxazole (TMP/SMX)-induced hypoglycaemia in a post kidney-pancreas transplant patient
AU  - Naseeruddin Khan
AU  - Numair Khan
AU  - Irfan Agha
AU  - Sareena Contractor
PY  - 2026
DA  - 2026/10/28
JO  - BMJ Case Reports
DO  - 10.1136/bcr-2026-275639
UR  - https://doi.org/10.1136/bcr-2026-275639
AB  - Single-strength trimethoprim/sulfamethoxazole (TMP/SMX) is standard prophylaxis against Pneumocystis jirovecii pneumonia in solid organ transplant recipients but hypoglycaemia at this prophylactic dose is rare. We report severe recurrent hypoglycaemia after TMP/SMX rechallenge in a man in his 30s who underwent simultaneous kidney-pancreas transplantation. TMP/SMX was withheld because of hyperkalaemia and temporarily replaced with nebulised pentamidine; after the hyperkalaemia resolved, single-strength TMP/SMX (trimethoprim 80 mg/sulfamethoxazole 400 mg once a day) was restarted, at which point renal allograft function and tacrolimus exposure were both stable. Four days later, the patient developed weakness and dizziness with home glucose readings of 28, 33 and 36 mg/dL on consecutive days. Symptoms resolved after drug withdrawal. A Naranjo score of 5 supported a probable TMP/SMX-associated adverse drug reaction, although the absence of paired biochemical testing during the episodes limits definitive mechanistic attribution.
SN  - 1757-790X
ER  -