Extensive pulmonary involvement with raltegravir-induced DRESS syndrome in a postpartum woman with HIV

Abstract

An 18-year-old postpartum woman with HIV, on lamivudine–zidovudine, lopinavir–ritonavir and raltegravir, presented with a 1-week history of rash and fevers. Initially admitted to obstetrics and gynaecology service for treatment of possible endometritis, she was transferred to the HIV medicine service for high fever, respiratory distress, hypotension and tachycardia. On admission, she was febrile (102°F) with findings of cervical and submandibular lymphadenopathy, diffuse morbilliform rash, generalised pruritus, facial oedema, and oedematous hands and feet. Consultations to various specialty services were initiated to rule out infectious, dermatological, rheumatological and drug-induced aetiologies. On the fourth day of hospitalisation, laboratory findings of significant eosinophilia and hepatitis (alanine aminotransferase 147 IU/L and aspartate aminotransferase 124 IU/L), in conjunction with the identification of the timing of medication use, led to a diagnosis of DRESS (drug reaction with eosinophilia and systemic symptoms) syndrome secondary to raltegravir. After discontinuing raltegravir and starting prednisone, her DRESS symptoms completely resolved.

Bronchoscopic Investigation of Atypical Drug-induced Hypersensitivity Syndrome Showing Viral Lung Involvement

“…There have been at least eight case reports of DIHS/ DRESS in the English literature showing pulmonary manifestations (12)(13)(14)(15)(16)(17)(18)(19) (Table), however, a histopathological evaluation was not performed in most cases. Six cases (cases 1-6) showed lung involvement as one of the initial manifestations of DIHS/DRESS within 0-2 weeks after the disease onset.…”

Review of integrase strand transfer inhibitors for the treatment of human immunodeficiency virus infection

“…Worsening of depression including suicidal ideation, particularly in patients with preexisting psychiatric disorders, has been reported, but it is less common (<2%) [6,28]. Serious adverse effects are rare, but rhabdomyolysis, fatal skin reactions such as Stevens-Johnson syndrome and toxic epidermal necrolysis, and drug reaction with eosinophilia and systemic symptoms syndrome characterized by rash, constitutional findings and organ dysfunction (e.g., elevated liver transaminases) have been reported [29][30][31][32][33][34][35]. However, clinical studies evaluating the association between RAL and skeletal muscle toxicity did not find any cases of rhabdomyolysis [36][37][38] ; p = 0.002) were independently associated with overall muscle toxicity.…”

Drug reaction with eosinophilia and systemic symptoms related to antiretroviral treatment in human immunodeficiency virus patients

“…Figure 1 depicts the flow chart followed during the selection process. A final sample of 35 cases was analyzed involving 5 antiretrovirals: Abacavir in 10 (28.6%) cases,[ 15 16 17 18 19 20 21 22 23 24 ] efavirenz in 6 (17.1%),[ 25 26 27 28 29 30 ] nevirapine in 12 (34.3%),[ 31 32 33 34 35 36 37 38 39 40 ] raltegravir in 6 (17.1%),[ 41 42 43 44 45 46 ] and tenofovir in 1 (2.9%) case. [ 47 ] Table 1 shows the characteristics of the included patients.…”