April 1989, Vol 149, No. 4 >

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ARTICLE | April 1989

Megaloblastic Pancytopenia Associated With Dapsone and Trimethoprim Treatment of Pneumocystis carinii Pneumonia in the Acquired Immunodeficiency Syndrome

DAVID S. McKINSEY, MD; DONNA DURFEE, PHARMD; PAULJ. KURTIN, MD

Arch Intern Med. 1989;149(4):965. doi:10.1001/archinte.1989.00390040157038.

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To the Editor.—Trimethoprim has been prescribed frequently in combination with sulfamethoxazole or dapsone for treatment of Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome (AIDS).^1,2 Use of these medications is associated with leukopenia in a substantial proportion of cases.³ Some authors have suggested that supplemental folinic acid (leucovorin) should be administered to prevent bone marrow suppression in patients with AIDS treated with sulfonamides.⁴ This issue has been controversial, however, and no clear consensus has emerged. We report a case in which treatment of P carinii pneumonia with trimethoprim and dapsone in a patient with AIDS and subclinical vitamin B₁₂ deficiency resulted in megaloblastic pancytopenia. This complication probably would have been prevented by use of supplemental folinic acid.

Report of a Case.—A 36-year-old man under our care for AIDS and P carinii pneumonia was treated with orally administered trimethoprim and dapsone. No other

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McKINSEY DS, DURFEE D, KURTIN PJ. Megaloblastic Pancytopenia Associated With Dapsone and Trimethoprim Treatment of Pneumocystis carinii Pneumonia in the Acquired Immunodeficiency Syndrome. Arch Intern Med. 1989;149(4):965. doi:10.1001/archinte.1989.00390040157038.

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Megaloblastic Pancytopenia Associated With Dapsone and Trimethoprim Treatment of Pneumocystis carinii Pneumonia in the Acquired Immunodeficiency Syndrome

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