Category: Drug-Induced Movement Disorders
Objective: We report the case of an elderly woman with hyperkinetic movement disorders
Background: Trimethoprim-sulfamethoxazole (TMP-SMX) is widely used for Pneumocystis jirovecii prophylaxis, but significant neurological toxicity remains extremely rare. Elderly patients and those with severe renal impairment are particularly susceptible to drug accumulation and adverse neurological effects.
Method: A 85 year old woman with newly diagnosed multiple myeloma and severe renal dysfunction who was receiving prophylactic TMP-SMX three times weekly. After one month, she developed rapidly progressive onset hyperkinetic movement disorders including generalized choreoathetosis, myoclonus predominant in proximal upper and lower limbs, and opsoclonus; associated with a middle confusion. Neurological investigations including EEG, brain MRI, cerebrospinal fluid analysis, and neuronal antibody testing were unremarkable. TMP-SMX was discontinued, resulting in rapid and complete resolution of all neurological symptoms within days.
Results: Although rare, TMP-SMX neurotoxicity has been described in isolated reports. This case highlights several risk factors such as advanced age, renal failure, and drug accumulation that can precipitate severe but reversible neurological manifestations. The strong temporal relationship and full recovery after drug withdrawal support a causal association.
Conclusion: Clinicians should consider TMP-SMX neurotoxicity in elderly or renally impaired patients presenting with acute neurological symptoms. Early recognition and prompt discontinuation of the drug can prevent morbidity and lead to full recovery.
MRI Flair
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To cite this abstract in AMA style:
M. Keita Sr, A. Ouedraogo, E E. Fanorena, C. Bekara, M. Abdallah. Rare Neurotoxicity of Cotrimoxazole A Movement Disorder Presentation In Elderly Patient [abstract]. Mov Disord. 2026; 41 (suppl 1). https://www.mdsabstracts.org/abstract/rare-neurotoxicity-of-cotrimoxazole-a-movement-disorder-presentation-in-elderly-patient/. Accessed October 1, 2026.« Back to 2026 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/rare-neurotoxicity-of-cotrimoxazole-a-movement-disorder-presentation-in-elderly-patient/