Antiretrovirals
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Toxic epidermal necrolysis: case report A 45-year-old man developed toxic epidermal necrolysis following treatment with darunavir, ritonavir, raltegravir and maraviroc for HIV infection [dosages not stated]. The man initiated rescue treatment with darunavir, ritonavir, raltegravir and maraviroc following failure of treatment with multiple antiretrovirals. A reduction in viral load and an increased in lymphocyte count were observed after 1 month, however 2 months later, he presented with pruritus, erythema, oedema and desquamation affecting almost the entire body. Antiretroviral treatment was discontinued and the man was given hydroxyzine and prednisone for the allergic reaction. Improvements were seen, therefore darunavir and raltegravir were re-introduced, however the reaction recurred with fever. Antiretroviral-induced toxic epidermal necrolysis was diagnosed after a full examination, and he was discharged without treatment and monitored. Two months later, after improvements in symptoms were seen, the man underwent skin tests for the antiretrovirals suspected to cause the reaction, all of which were negative. An alternative treatment in the form of tipranavir was suggested, however an epicutaneous patch test gave a positive result for tipranavir after 48 hours. He underwent a desensitisation programme for tipranavir, in which he took all doses without complications. He was discharged for outpatient monitoring with lamivudine, enfuvirtide and tipranavir/ritonavir. At 6 months’ follow-up, he remained without complications. Martinez Castro B, et al. Desensitization to tipranavir caused by toxicodermia. Farmacia Hospitalaria 33: 340-342, No. 6, Nov-Dec 2009. Available from: URL: http://dx.doi.org/10.1016/S1130-6343%2809%2972981-2 [Spanish; summarised 803007259 from a translation] - Spain
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Reactions 13 Mar 2010 No. 1292
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