CTICasesTrimethoprim-Sulfamethoxazole (Bactrim)-Induced Acute Eosinophilic Pneumonia Progressing to ARDS and Fibrosis
[...]. Trimethoprim-Sulfamethoxazole (Bactrim)-Induced Acute Eosinophilic Pneumonia Progressing to ARDS and Fibrosis. CTICases. Published October 1, 2026. https://cticases.com/c/cjnzs
Imaging findings
An inpatient after stem cell transplant had a prior CT showing only dependent atelectasis with otherwise clear lungs. After starting trimethoprim-sulfamethoxazole, the patient developed acute shortness of breath, and CT showed peripheral consolidation that was worse in the lower lungs and basal-predominant. This progressed to diffuse lung disease consistent with ARDS. The last CT shows widespread cystic change from ARDS, and the latest radiograph shows the patient on ECMO while being prepared for lung transplant. The whole course took only a few weeks.
Key takeaways
Trimethoprim-sulfamethoxazole is widely used but can cause acute eosinophilic pneumonia. This can progress to ARDS, severe respiratory failure, and fibrosis needing ECMO and transplant. New peripheral, basal-predominant consolidation after starting a drug should suggest an eosinophilic drug reaction, and the course can be very fast.
AI-assisted summary — may contain errors. Verify against the source video. Learn more
More from this webinar
- Rhizopus Bronchitis at the Bronchial Anastomosis after Double Lung TransplantInfection
- Paraesophageal Hiatal Hernia with Intrathoracic Gastric Volvulus and Partial Outlet ObstructionOther
- Disseminated Varicella Pneumonia with Acute Lung Injury after Double Lung TransplantInfection
- Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia (DIPNECH)Neoplastic
- Pulmonary Nocardiosis in a Stem Cell Transplant RecipientInfection
- Pneumocystis jirovecii Pneumonia during Dapsone ProphylaxisInfection
- Morgagni Hernia Containing Omental FatCongenital
- Complicated Silicosis with Progressive Massive Fibrosis in a Well Digger and Concrete CutterExposure
See all cases from October 1, 2026 →