The Treatment of Wegener's Granulomatosis With Sulfamethoxazole and Trimethoprim

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To the Editor.—The recent report by Israel1 presents the use of sulfamethoxazole and trimethoprim as a major advance in the treatment of Wegener's granulomatosis. I find this report unconvincing and premature. All observations are doubtful. For example, patient 7 had limited lung disease; this form of the disease can resolve spontaneously. The same remark can be made for patient 5 who was not "acutely ill" and had "urinary cast" as the sole evidence for renal involvement! Patient 6 was treated with sulfamethoxazole and trimethoprim alone, but only for nasal symptoms, and there was no evidence for systemic disease activity. Patient 9 was receiving sulfamethoxazole and trimethoprim when the disease relapsed, but was also receiving 50 mg/d of cyclophosphamide. In this regard this article looks like previous articles on the same topic,2,3 and fails to consider a very important aspect of Wegener's granulomatosis: What can be called a relapse

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