Drug rash with eosinophilia and systemic symptoms syndrome and renal toxicity with a nevirapine-containing regimen in a pregnant patient with human immunodeficiency virus.
BACKGROUND
Antiretroviral therapy is associated with serious adverse events. We report the case of a pregnant human immunodeficiency virus type 1-infected woman who developed drug rash with eosinophilia and systemic symptoms syndrome and renal failure shortly after initiation of a nevirapine-containing antiretroviral regimen at 27 weeks' gestation.


METHODS
A 26-year-old primigravida presented with a fever of 40.2C, urticarial rash, and icteric sclera 6 weeks after starting a nevirapine-containing antiretroviral regimen. Eosinophils, serum creatinine, bilirubin, and liver enzymes were markedly elevated, and abnormal coagulation studies were noted on admission. Serology testing was negative for viral hepatitis and microbiologic cultures were negative for growth. Abnormal laboratory findings at discharge resolved within 4 months after discontinuation of antiretroviral agents and systemic corticosteroid therapy.


CONCLUSIONS
Our case suggests the need for close monitoring of liver and renal function after initiation of nevirapine-containing antiretroviral regimens.
Division of Infectious Diseases College of Medicine, Ohio State University, Columbus, Ohio 43210-1291, USA.
Eric
E
Knudtson
Michael
M
Para
Hillary
H
Boswell
Patty
P
Fan-Havard
D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects*; D023241:Antiretroviral Therapy, Highly Active; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology*; D003875:Drug Eruptions / Q000209:etiology*; D004802:Eosinophilia / Q000139:chemically induced*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy; D015497:HIV-1; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced*; D019829:Nevirapine / Q000009:adverse effects*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy; D013577:Syndrome
D019380:Anti-HIV Agents; D019829:Nevirapine