ritonavir and Brain-Diseases

Reversible splenial lesion syndrome (RESLES) is a recently identified clinico-radiological syndrome, the etiology is miscellaneous. Atrial septal defect (ASD) as an underlying etiology for RESLES has not been reported. We first report a rare case of RESLES associated with ASD. The clinical, radiological, and ultrasonic profiles were presented and the pathophysiological mechanism was analyzed.. A 23-year-old man presented with headache, drowsiness, occasional paraphasia, and paroxysmal dry cough. Brain magnetic resonance imaging (MRI) on admission showed an ovoid isolated lesion in the splenium of corpus callosum, which exhibited hyperintensity on diffusion-weighted imaging and hypointensity on apparent diffusion coefficient, and completely disappeared on the follow-up MRI 14 days later. ASD was found by transthoracic echocardiography, Right-to-left shunts were detected on color Doppler of transesophageal echocardiography, and microemboli were captured by transcranial Doppler ultrasound.. According to his clinical history and imaging results, we confirmed the diagnosis of RESLES associated with ASD.. The patient was treated by oral aspirin and lopidogrel sulfate to inhibit platelet aggregation. In addition, oral nimodipine to suppress vasoconstriction.. After 14 days treatment, all the symptoms presenting on admission resolved completely. Subsequently, a repair surgery of ASD under thoracoscopy was successfully performed.. To our knowledge, this is the first reported case of ASD may be an underlying etiology for RESLES and need require an etiotropic treatment.

Topics: Administration, Oral; Antihypertensive Agents; Aspirin; Brain Diseases; Corpus Callosum; Diffusion Magnetic Resonance Imaging; Drug Combinations; Drug Therapy, Combination; Echocardiography; Follow-Up Studies; Headache; Heart Septal Defects, Atrial; Humans; Lopinavir; Male; Nimodipine; Platelet Aggregation Inhibitors; Ritonavir; Syndrome; Treatment Outcome; Ultrasonography, Doppler, Transcranial; Young Adult

Up to 50% of patients with severe immune deficiency experience an excessive inflammatory response called immune reconstitution inflammatory syndrome (IRIS) after the initiation of antiretroviral therapy (ART). IRIS has been observed after various opportunistic infections with pathogens such as mycobacteria, including Bacille Calmette-Guérin, cryptococci, human herpesvirus-8, non-Hodgkin's lymphoma, and progressive multifocal leukoencephalopathy. Non-acquired immune deficiency-defining illnesses can also deteriorate after commencement of ART. Renal IRIS has been reported in a few patients with mycobacterial infections, but to the best of our knowledge no cases of nephrotic syndrome and IRIS have been described.. We report the case of an infant with human immunodeficiency virus-1 (HIV-1) infection, Pneumocystis pneumonia, and encephalopathy. During immune reconstitution the patient developed nephrotic syndrome. Treatment of nephrotic syndrome was initiated with prednisone, an angiotensin-converting enzyme inhibitor (lisinopril), and low-molecular-weight heparin. ART was continued, but only a low level of lopinavir/ritonavir could be achieved. There was no relapse of nephrotic syndrome during 10 months of follow-up.. Nephrotic syndrome may occur in infants during immune reconstitution and should not be overlooked.

Topics: Anti-Retroviral Agents; Brain Diseases; Drug Combinations; HIV Infections; HIV-1; Humans; Immune Reconstitution Inflammatory Syndrome; Infant; Lopinavir; Nephrotic Syndrome; Pneumonia, Pneumocystis; Ritonavir