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Researchers propose identifying TMP-SMX hypersensitivity reactions as SCoRCH: JAMA
USA: In a recent retrospective case series published in JAMA Dermatology, the researchers have described the mucocutaneous findings and clinical features of trimethoprim-sulfamethoxazole (TMP-SMX) hypersensitivity reaction.
TMP-SMX hypersensitivity reaction ranges from circulatory shock to aseptic meningitis and respiratory failure and is a potentially life-threatening condition having dermatologic relevance.
Madeleine O'Brian, University of Texas Southwestern Medical Center, Dallas, and colleagues in their study have proposed that TMP-SMX hypersensitivity reaction be identified as SCoRCH (sudden conjunctivitis, rash, and lymphopenia combined with hemodynamic changes). This is considering the clinical and mucocutaneous features of TMP-SMX hypersensitivity reactions that are distinct from those of other drug reactions and are potentially life-threatening.
The authors addressed the question, "what are the clinical features and mucocutaneous findings of an increasingly recognized hypersensitivity reaction associated with hemodynamic changes after using trimethoprim-sulfamethoxazole?"
The study was a retrospective case series study of 7 patients who developed hemodynamic changes, a characteristic rash, and end-organ dysfunction after treatment with trimethoprim-sulfamethoxazole at an extensive university hospital system from January 2013 to March 2022.
The cohort consisted of seven patients (median age, 20 years; 4 female and three male).
The study led to the following findings:
- The most common mucocutaneous findings were generalized sunburn-like erythema without scale, conjunctivitis, and mild facial and acral oedema.
- Three patients had previous exposure to TMP-SMX and developed symptoms in 1 day or less, while those without exposure presented from 4 to 11 days after drug initiation.
- Among the seven patients, six had a fever, 7 had hypotension, and 7 had tachycardia.
- All patients had lymphopenia and evidence of end-organ dysfunction with either kidney or liver involvement. The median time to resolution was 72 hours.
"Our findings suggest that SCoRCH refers to sudden lymphopenia, conjunctivitis, and rash combined with hemodynamic changes, should be considered for the differential diagnosis of patients presenting with acute generalized sunburn-like conjunctivitis, erythema, hemodynamic changes, and systemic symptom in the setting of recent use of TMP-SMX," the researchers concluded.
About Trimethoprim-Sulfamethoxazole
Trimethoprim-sulfamethoxazole is a combination chemotherapeutic agent and a commonly used antibiotic. Adverse drug reactions happen in 6-8% of patients. The most common adverse reactions include mild gastrointestinal distress and cutaneous events, a wide range of haematological abnormalities have also been ascribed to TMP-SMX.
Reference:
O'Brian M, Rose EK, Mauskar MM, Dominguez AR. Sudden Conjunctivitis, Lymphopenia, and Rash Combined With Hemodynamic Changes (SCoRCH) After Trimethoprim-Sulfamethoxazole Use: A Case Series Study of a Hypersensitivity Reaction. JAMA Dermatol. Published online November 09, 2022. doi:10.1001/jamadermatol.2022.4657
MSc. Biotechnology
Medha Baranwal joined Medical Dialogues as an Editor in 2018 for Speciality Medical Dialogues. She covers several medical specialties including Cardiac Sciences, Dentistry, Diabetes and Endo, Diagnostics, ENT, Gastroenterology, Neurosciences, and Radiology. She has completed her Bachelors in Biomedical Sciences from DU and then pursued Masters in Biotechnology from Amity University. She has a working experience of 5 years in the field of medical research writing, scientific writing, content writing, and content management. She can be contacted at  editorial@medicaldialogues.in. Contact no. 011-43720751
Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751