• PDF / 184,238 Bytes
• 1 Pages / 595.245 x 841.846 pts (A4) Page_size
• 89 Downloads / 165 Views

DOWNLOAD

REPORT

---

1

★S

Immune reconstitution syndrome manifesting as acute appendicitis (first report): case report A 33-year-old man with HIV infection developed immune reconstitution syndrome (IRIS) manifesting as acute appendicitis during treatment with antiretrovirals and enfuvirtide. The man had been receiving antiretroviral treatment for the past 16 years. His treatment was switched from enfuvirtide, tenofovir and lamivudine, which he had been receiving for 18 months, to tipranavir/ritonavir, tenofovir and enfuvirtide [dosages not stated]. He was hospitalised 26 days later with a 3-day history of vomiting and intense lower right abdominal pain. His WBC count was 5.3 × 103 cells/µL, and his CRP level was 73.4 mg/L. An ultrasound revealed a thickened appendix with enlarged lymph nodes, and infiltration of surrounding tissues; acute appendicitis was suspected. The man underwent laparotomy; perioperative and postoperative findings showed gangrenous appendicitis with periappendiceal infiltration. Treatment with amoxicillin/clavulanic acid and metronidazole was started, with a good postoperative course. He was discharged after 10 days. Sixteen days after surgery, he had a HIV RNA viral load of 472 copies/mL, and a CD4 lymphocyte count of 419 cells/µL. Author comment: "[T]he onset of acute appendicitis could be incidental, but we assume, that this case meets very well all criteria of typical IRIS." Machala L, et al. Acute appendicitis as a manifestation of the immune reconstitution inflammatory syndrome. Current HIV Research 7: 473-474, No. 5, 1 Sep 2009. Available from: URL: http://dx.doi.org/10.2174/157016209789346309 803004285 Czech Republic

»

Editorial comment: A search of AdisBase, Embase and Medline did not reveal any previous case reports of appendicitis associated with enfuvirtide, tipranavir, ritonavir or tenofovir. The WHO ADR database contained three reports of appendicitis associated with enfuvirtide, no reports of appendicitis associated with tipranavir, six reports of appendicitis associated with ritonavir and four reports of appendicitis associated with tenofovir.

0114-9954/10/1284-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved

Reactions 16 Jan 2010 No. 1284