title: [Fatal lactic acidosis in a patient with acquired immunodeficiency syndrome treated with stavudine, lamivudine and indinavir].
abstract: Recently, several class-related adverse events have been recognized with antiretroviral drugs. For nucleoside analogue reverse transcriptase inhibitors. (NRTI), lactic acidosis with hepatomegaly and hepatic steatosis have been reported. These appear to occur at a low frequency, but with a high fatality rate. We report a case of fatal lactic acidosis in a patient with acquired immunodeficiency syndrome (AIDS) treated with stavudine (d4T), lamivudine (3TC) and indinavir (IDV). A 48-year-old male AIDS patient was admitted with complaints of general fatigue and dyspnea. His medications at presentation included d4T, 3TC and IDV. Physical examination demonstrated icteric sclerae and abdominal tenderness with hepatomegaly. Laboratory data demonstrated a severe metabolic acidosis with an anion gap due to lactate accumulation. Despite intensive treatment, cardiorespiratory arrest occurred and this could not be resuscitated.
authors.affiliation: First Department of Internal Medicine, Kurume University School of Medicine.
authors.forename: K
authors.initials: K
authors.lastname: Tanaka
authors.forename: S
authors.initials: S
authors.lastname: Fukahori
authors.forename: H
authors.initials: H
authors.lastname: Jojima
authors.forename: Y
authors.initials: Y
authors.lastname: Fujimatsu
authors.forename: K
authors.initials: K
authors.lastname: Shiraishi
authors.forename: M
authors.initials: M
authors.lastname: Tanaka
authors.forename: Y
authors.initials: Y
authors.lastname: Okubo
authors.forename: J
authors.initials: J
authors.lastname: Honda
authors.forename: K
authors.initials: K
authors.lastname: Oizumi
mesh_terms: D000140:Acidosis, Lactic / Q000139:chemically induced*; D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy*; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D017809:Fatal Outcome; D006801:Humans; D019469:Indinavir / Q000008:administration & dosage* / Q000009:adverse effects; D019259:Lamivudine / Q000008:administration & dosage* / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects*; D018119:Stavudine / Q000008:administration & dosage* / Q000009:adverse effects*
chemical_list: D019380:Anti-HIV Agents; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine; D019469:Indinavir; D018119:Stavudine