Raltegravir
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First report of peritonitis: case report A 49-year-old man developed peritonitis during treatment with raltegravir for HIV infection. The man had a history of hemophilia, hepatitis C and HIV and had been receiving abacavir, nevirapine and lopinavir/ ritonavir. Raltegravir [dosage not stated] was administered in place of lopinavir/ritonavir due to bleeding problems. On day 18 of receiving raltegravir he presented with a 3-day history of progressive pain in the lower chest wall and the right upper abdomen. After treatment with a NSAID proved unsuccessful, a CT scan was carried out. The scan showed contrast enhancement of the liver surface and fatty stranding of the greater omentum consistent with peritonitis. Prednisone therapy was initiated and his symptoms resolved. After the discontinuation of prednisone his symptoms returned and therapy was reinitiated. Gradual reduction in the prednisone dose exacerbated his abdominal pain and resulted in stomatitis. Prednisone therapy was continued at a higher dose and 11 weeks after the onset of his symptoms, raltegravir was changed back to lopinavir/ritonavir. After 4 days, all antiretroviral therapy was withdrawn due to bleeding and diarrhoea associated with lopinavir/ritonavir. His symptoms regressed and the dosage of prednisone was reduced. Investigations showed his C-reactive protein was elevated during raltegravir therapy with normal levels achieved 6 days after cessation. An improvement of perihepatic enhancement was seen in a CT scan carried out 10 days after the withdrawal of raltegravir. Tsukada K, et al. Raltegravir-associated perihepatitis and peritonitis: A single case report. AIDS 24: 160-161, No. 1, 2 Jan 2010. Available from: URL: http:// 803006647 dx.doi.org/10.1097/QAD.0b013e328333d28d - Japan
» Editorial comment: A search of AdisBase, Medline and Embase did not reveal any previous case reports of peritonitis associated with raltegravir. The WHO ADR database contained no reports of peritonitis associated with raltegravir.
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Reactions 6 Mar 2010 No. 1291
