ritonavir and Ischemia

Topics: Adult; Computed Tomography Angiography; Cytochrome P-450 CYP3A Inhibitors; Ergotamine; Ergotism; Female; HIV Infections; Humans; Ischemia; Leg; Migraine Disorders; Pain; Ritonavir

Ergotism is an ischaemic complication due to vasoconstriction throughout the body due to ingestion of ergotamine. A 34-year-old Hispanic man with HIV infection treated with saquinavir, ritonavir and abacavir/lamivudine presented to the emergency department complaining of left foot pain 1 week prior to admission. The affected extremity was cold with absence of pedal and tibial pulses. Arterial Doppler revealed absent arterial flow from the popliteal artery later confirmed by arteriography. Medication reconciliation revealed a recent prescription for migraine headache containing ergotamine. Drug was discontinued and the patient was started on cilostazol, enoxaparin and nitroglycerin patches on the affected limb. Complete resolution of symptoms and arteriography findings occurred 2 days after therapy began.

Topics: Adult; Anti-HIV Agents; Anticoagulants; Cilostazol; Cytochrome P-450 CYP3A Inhibitors; Dideoxynucleosides; Drug Combinations; Drug Interactions; Enoxaparin; Ergotamine; Ergotism; Headache; HIV Infections; Humans; Ischemia; Lamivudine; Lower Extremity; Male; Nitroglycerin; Ritonavir; Saquinavir; Tetrazoles; Tibial Arteries; Ultrasonography, Doppler, Color; Vasoconstrictor Agents; Vasodilator Agents

Topics: Adult; Ergotamine; Ergotism; Female; HIV Infections; HIV Protease Inhibitors; Humans; Ischemia; Leg; Lymphoma; Ritonavir; Vasoconstrictor Agents

We report the case of a 57-year-old man who presented bilateral subacute and painless optic neuropathy after meningopolyradiculitis revealing a primary human immunodeficiency virus infection. Both antiretroviral and steroid treatments were ineffective. Clinical symptoms and evolutive pattern were consistent with a mechanism of microvascular ischaemia of the optic nerve head. Optic neuropathies related to HIV infection are rare compared to those resulting from opportunistic infections. There are several pathophysiological mechanisms involved.

Topics: AIDS Serodiagnosis; Anti-HIV Agents; Antiretroviral Therapy, Highly Active; Disease Progression; Drug Therapy, Combination; Evoked Potentials, Visual; Facial Nerve Diseases; HIV Infections; HIV Protease Inhibitors; HIV-1; Humans; Ischemia; Lamivudine; Lopinavir; Male; Meningitis, Viral; Methylprednisolone; Middle Aged; Optic Disk; Optic Nerve Diseases; Polyradiculopathy; Pyrimidinones; Reverse Transcriptase Inhibitors; Ritonavir; Visual Fields; Zidovudine

Topics: Anti-HIV Agents; Drug Interactions; Ergotamine; Humans; Ischemia; Leg; Ritonavir; Vasoconstrictor Agents