PMC9513843_01
Patient development. Day -21: ambulatory evaluation when trimethoprim/sulfamethoxazole (TMP/SMX) was indicated for suspected pneumocystis. Day -14: emergency room consultation. Day -1: -ambulatory evaluation. Day 0: hospital admission. First shaded region: time exposed to SMX. Second shaded region: urinary alkalization was performed. All urinalysis was automated (both chemistry and microscopy). On day 2, urinalysis microscopy included a skilled medical technologist evaluation (from this sample, SMX crystals was obtained by transform infrared spectroscopy).
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Figure1
Two months before admission, she was hospitalized for COVID-19 pneumonia that responded to steroids and oxygen support, being discharged with 30 mg per day of prednisone and normal kidney function (Figure 1).
Sulfamethoxazole crystals. A: Bright field (x 40). B: Polarized light (x 40). C: Transform infrared spectroscopy (FT-IR) of the patient's urinary crystals. D: Library spectra most similar to patient's FT-IR: chloroquine (yellow, concordance 19.5%); sodium urate + whewellite + amorph. phosphate (light blue, concordance 20.2%); 4-phenylurazole (green, concordance 24.8%); N,N-dimethylformamide (pink, concordance 26.8%); N-acetylsulfamethoxazole (blue, concordance 96.4%).
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Figure2
The crystals had an irregular spheric shape and radial striations, yellow to brown color, and strong positive birefringence (Figure 2).