[A rare etiology of hepatic steatosis associated with lactic acidosis: the toxicity of antiviral nucleoside analogues].
We report three cases of hepatic steatosis associated with lactic acidosis occurring in HIV positive patients and due to a toxicity of antiviral nucleoside analogues. The clinico-pathological presentation was similar associating digestive signs (vomiting and abdominal pain), polypnea, lactic acidosis, a lethal clinical course, and an hepatomegaly with a diffuse macrovacuolar steatosis. The ultrastructural study performed in two cases showed mitochondrial alterations in hepatocytes. The toxicity of antiviral nucleoside analogues is due to a mitochondrial DNA polymerase inhibition. The incidence of this disease is actually low but probably underestimated. The diagnosis should be rapidly performed and the treatment immediatly interrupted.
Bienvenu
L
L
Service d'Anatomie Pathologique, CHG Robert Ballanger, 93602 Aulnay-sous-Bois cedex.
Burel
F
F
Hofman
V
V
Itchaï
C
C
Amaro
J
J
Hofman
P
P
D000140:Acidosis, Lactic / Q000150:complications*; D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects*; D000963:Antimetabolites / Q000009:adverse effects*; D016049:Didanosine / Q000009:adverse effects; D017809:Fatal Outcome; D005234:Fatty Liver / Q000139:chemically induced* / Q000150:complications / Q000473:pathology; D005260:Female; D006679:HIV Seropositivity / Q000188:drug therapy; D006801:Humans; D019259:Lamivudine / Q000009:adverse effects; D008854:Microscopy, Electron; D008930:Mitochondria, Liver / Q000201:enzymology / Q000473:pathology; D018119:Stavudine / Q000009:adverse effects; D015215:Zidovudine / Q000009:adverse effects
D019380:Anti-HIV Agents; D000963:Antimetabolites; D019259:Lamivudine; D015215:Zidovudine; D018119:Stavudine; D016049:Didanosine