raltegravir-potassium and Eosinophilia

We present the first published case of raltegravir-associated drug-reaction with eosinophilia and systemic symptoms (DRESS) syndrome in a child without characteristic human leukocyte antigen haplotypes HLA-B*57:01 or HLA-B*53:01. A 4-year-old African American female with perinatally acquired human immunodeficiency virus infection was hospitalized for DRESS after starting a raltegravir-based antiretroviral regimen.

Topics: Alleles; Child; Child, Preschool; Drug Hypersensitivity Syndrome; Eosinophilia; Female; HLA Antigens; HLA-B Antigens; Humans; Pharmaceutical Preparations; Raltegravir Potassium

Topics: Child; Drug Eruptions; Drug Hypersensitivity Syndrome; Eosinophilia; Female; Humans; Raltegravir Potassium

This case report describes two severe antiretroviral drug adverse reactions that occurred in the same patient. A 55-year-old HIV-positive African woman received a single epidural triamcinolone injection for pain relief of postherpetic neuralgia. Forty-one days later, she developed severe iatrogenic Cushing's syndrome due to the drug-drug interaction between triamcinolone and her boosted protease inhibitor therapy. The patient's antiretroviral regimen was thus changed to replace her protease inhibitor with the integrase inhibitor raltegravir. Shortly after commencing the drug, the patient developed a severe adverse drug reaction manifesting as Drug Reaction (or Rash) with Eosinophilia and Systemic Symptoms (DRESS) syndrome. First described in 1996, this hypersensitivity syndrome presents with severe skin reaction as well as fever, rash, lymphadenopathy and internal organ involvement with marked eosinophilia. Clinicians should be aware of raltegravir-induced DRESS syndrome as well as the potential for drug-drug interactions due to protease inhibitor-based therapy.

Topics: Anti-HIV Agents; Anti-Inflammatory Agents; Antiretroviral Therapy, Highly Active; Drug Hypersensitivity Syndrome; Drug Interactions; Eosinophilia; Exanthema; Female; Fever; HIV Infections; HIV Integrase Inhibitors; Humans; Neuralgia, Postherpetic; Patient Safety; Pyrrolidinones; Raltegravir Potassium; Treatment Outcome; Triamcinolone

DRESS syndrome (drug reaction with eosinophilia and systemic symptoms) is a life-threatening adverse drug reaction. Raltegravir is an integrase inhibitor used in HIV-1 infection. We report on a patient who developed a DRESS syndrome under raltegravir treatment, which was identified as a probable case of DRESS on the basis of Kardaun and Naranjo scores. The presented case is the first description of a proven raltegravir-induced DRESS syndrome.

Topics: Anti-HIV Agents; Eosinophilia; Female; HIV Infections; Humans; Middle Aged; Pyrrolidinones; Raltegravir Potassium

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome or drug-induced hypersensitivity is a potentially life-threatening drug hypersensitivity syndrome most commonly associated with anticonvulsants, allopurinol, long-acting sulfonamides, dapsone, and minocycline. In the setting of HIV infection, the antiretroviral medicines abacavir, nevirapine, and efavirenz have all shown well-documented associations with DRESS syndrome. There has only been one case (in a poster presentation) of this syndrome in a patient who was taking raltegravir.

Topics: Drug Hypersensitivity; Eosinophilia; Female; HIV Integrase Inhibitors; Humans; Middle Aged; Pyrrolidinones; Raltegravir Potassium; Syndrome