Dolutegravir
- PDF / 170,499 Bytes
- 1 Pages / 595.245 x 841.846 pts (A4) Page_size
- 105 Downloads / 147 Views
1
S
Acute myocarditis: case report A 35-year-old man developed acute myocarditis during treatment with dolutegravir for HIV infection. The man presented with acute precordial and retrosternal pain, which started 90 minutes after running. The pain radiated to the right mammary and palmar region. His medical history was significant for syphilis (diagnosed 5 years ago), and HIV infection, which was diagnosed 6 years ago. Initially, he received antiretroviral treatment with lamivudine, tenofovir and efavirenz. Eight days following the treatment initiation, he developed transient generalised rash secondary to efavirenz. However, efavirenz was continued. A drop in the plasma HIV viral load was subsequently achieved. Two months prior to this presentation, efavirenz was switched to dolutegravir 50 mg/day [route not stated] due to sleep disturbance (an adverse-effect of efavirenz). At the current hospitalisation, ECG showed elevated ST-segment in several leads, which were consistent with myocarditis. Echocardiography was unremarkable for pericardial effusion or ventricular dysfunction. Laboratory investigation showed increased creatine phosphokinase and troponin-I level, that continued to increase three hours later. Aspartate aminotransferase was within the normal range. Additionally, cardiac catheterisation was non-significant for coronary disease. A cardiac MRI showed delayed gadolinium enhancement in the midendocardial region, mainly in the inferior and lateral walls, with sparing of the sub-endocardial region and the diagnosis of myocarditis was confirmed. Thereafter, the myocarditis resolved completely. After 9 days, he was discharged on aspirin and enalapril. The myocarditis was considered secondary to dolutegravir. The man’s antiretroviral treatment with dolutegravir was therefore switched to ritonavir boosted darunavir, along with lamivudine and tenofovir. Author comment: "The temporal relationship between the development of myocarditis and the initiation of dolutegravir in this antiretroviral-experienced patient strongly suggests a drug-related event." Eyer-Silva WDA, et al. Acute myocarditis after switch to dolutegravir: A reminder of potential toxicity of integrase inhibitor-including HAART. AIDS 33: 2105-2107, No. 13, 1 Nov 2019. Available from: URL: http://doi.org/10.1097/ 803431782 QAD.0000000000002322 - Brazil
0114-9954/19/1778-0001/$14.95 Adis © 2019 Springer Nature Switzerland AG. All rights reserved
Reactions 9 Nov 2019 No. 1778
Data Loading...
