PURPOSE: The case of a patient who developed aseptic meningitis, hemolytic 
anemia, hepatitis, and orthostatic hypotension simultaneously during treatment 
with trimethoprim-sulfamethoxazole is described.
BACKGROUND: A healthy 37-year-old African- American man was receiving treatment 
with trimethoprim-sulfamethoxazole double strength. This was the patient's first 
experience with trimethoprim- sulfamethoxazole, and he was not taking any other 
medications during the treatment period. He had been taking 
trimethoprim-sulfamethoxazole for approximately eight days when he revisited his 
family physician, complaining of headaches, dizziness, difficulty with speech, 
weakness, and itching on the trunk of his body and legs, where a maculopapular 
rash was noted. Orthostatic hypotension was also noted at that visit, with a 
standing blood pressure measurement of 95/80 mm Hg. Based on these findings and 
since the patient had no signs of infection, his physician instructed him to 
discontinue the drug. The patient was admitted to the emergency department of a 
local hospital within two days due to ongoing headache, elevated temperature, 
and nuchal rigidity, symptoms suggestive of meningitis. Because of the presence 
of hemolysis, the patient underwent testing for glucose-6-phosphate 
dehydrogenase (G6PD) deficiency, for which he tested positive. The patient was 
discharged five days after admission and referred to a hematology clinic for 
follow-up. The patient has since returned to his routines of daily living and 
has reported no fatigue or other lingering adverse symptoms.
CONCLUSION: A 37-year-old African- American man with G6PD deficiency developed 
hemolytic anemia, hepatitis, orthostatic hypotension, and aseptic meningitis 
simultaneously after using trimethoprim-sulfamethoxazole.