Intravenous ribavirin and hyperammonemia in an immunocompromised patient infected with adenovirus.
Ribavirin is a synthetic guanosine analog with activity against DNA and RNA viruses. It was studied in human trials, and no marked adverse effect was reported beyond the potential for teratogenicity and reversible mild anemia. An 8-year-old girl received a multivisceral transplant and developed adenoviral pneumonia. She was treated with intravenous ribavirin and became hyperammonemic. Discontinuation of ribavirin led to a decrease in ammonia levels. This pattern was repeated when the drug was restarted and discontinued. We hypothesize that in a toxic environment the interaction of ribavirin with hepatocellular mitochondrial enzymes may lead to hyperammonemia.
Bertrand
P
P
Department of Pediatrics, University of Miami, Florida, USA.
Faro
A
A
Cantwell
P
P
Tzakis
A
A
D000257:Adenoviridae Infections / Q000188:drug therapy*; D000641:Ammonia / Q000097:blood; D000998:Antiviral Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D005260:Female; D006801:Humans; D022124:Hyperammonemia / Q000097:blood / Q000139:chemically induced*; D016377:Organ Transplantation / Q000009:adverse effects*; D011024:Pneumonia, Viral / Q000188:drug therapy*; D012254:Ribavirin / Q000009:adverse effects* / Q000627:therapeutic use
D000998:Antiviral Agents; D012254:Ribavirin; D000641:Ammonia