Acute fulminant hepatic failure in a woman treated with phenytoin and trimethoprim-sulfamethoxazole

Massive hepatic necrosis following exposure to phenytoin and trimethoprim-s ulfamethoxazole is a rare occurrence and to the best of our knowledge has n ot been reported previously. Acute hepatic failure following administration of trimethoprim-sulfamethoxazole has rarely been seen, and only 4 cases ha ve been well documented pathologically. We report a case of acute liver fai lure in a 60-year-old woman following ingestion of phenytoin and trimethopr im-sulfamethoxazole concomitantly over a 9-day period. Autopsy findings rev ealed acute fulminant hepatic failure. This case demonstrates the effects o f chemical-chemical interactions in the potentiation of hepatotoxicity of s ingle agents and specifically illustrates the need for discontinuing trimet hoprim-sulfamethoxazole in the presence of early liver injury.