Sodium stibogluconate
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Sodium stibogluconate Varicella zoster virus infection, aseptic meningitis and herpes zoster: case report A 21-year-old man developed aseptic meningitis and herpes zoster secondary to varicella zoster virus infection during treatment with sodium stibogluconate for relapsed cutaneous Leishmania major infection. The man, who had a history of chickenpox, eczema and atopy, received a second course of IV sodium stibogluconate 20 mg/kg/day. On day 17 of treatment, he noted the onset of a headache that increased in severity over the following day. It was associated with photophobia, nausea, retro-orbital pain, neck stiffness and vomiting. In an emergency room, an evaluation revealed mild nuchal rigidity, a temperature of 101.6°F, healing leishmaniasis sores and petechial-appearing patches under his right axillary area and his back. His WBC count contained 11% lymphocytes and he had a CD4 cell count of 403/cmm. Cerebrospinal fluid (CSF) sampling revealed a RBC count of 28, a WBC count of 868 with 82% lymphocytes, a protein level of 97 mg/dL (normal 12–60) and a glucose level of 48 mg/dL. His serum glucose level was 82 mg/dL. The following day, he had a clustered vesicular rash in his right thoracic T1 dermatome. A direct fluorescent antibody test from a vesicle scraping was positive for varicella zoster virus. PCR analysis of CSF was positive for varicella zoster virus DNA. His serum varicella zoster virus IgG was 3.30 ISR (normal 0–1.09). The man received IV aciclovir, and his symptoms improved markedly. He also received a 7-day course of valaciclovir therapy. Sodium stibogluconate was discontinued after he had received 18 doses. At a 2-month follow-up, he reported no sequelae after the varicella zoster virus meningitis, and healing of his skin lesions. Hartzell JD, et al. Varicella zoster virus meningitis complicating sodium stibogluconate treatment for cutaneous leishmaniasis. American Journal of Tropical 801040978 Medicine and Hygiene 74: 591-592, No. 4, Apr 2006 - USA
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Reactions 12 Aug 2006 No. 1114
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