title: 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.
authors.affiliation: Department of Medicine, UCSD, La Jolla, California, USA.
authors.forename: Brittany Elizabeth
authors.initials: BE
authors.lastname: Yee
authors.forename: Nghia Hoang
authors.initials: NH
authors.lastname: Nguyen
authors.forename: Daniel
authors.initials: D
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D019380:Anti-HIV Agents / Q000627:therapeutic use; D004338:Drug Combinations; D063926:Drug Hypersensitivity Syndrome / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D019428:HIV Integrase Inhibitors / Q000009:adverse effects*; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use; D061466:Lopinavir / Q000627:therapeutic use; D010996:Pleural Effusion / Q000000981:diagnostic imaging* / Q000209:etiology; D049590:Postpartum Period; D011760:Pyrrolidinones / Q000009:adverse effects*; D011859:Radiography; D000068898:Raltegravir Potassium; D012128:Respiratory Distress Syndrome / Q000000981:diagnostic imaging* / Q000209:etiology; D019438:Ritonavir / Q000627:therapeutic use; D015215:Zidovudine / Q000627:therapeutic use
chemical_list: D019380:Anti-HIV Agents; D004338:Drug Combinations; D019428:HIV Integrase Inhibitors; D011760:Pyrrolidinones; C109078:lamivudine, zidovudine drug combination; C558899:lopinavir-ritonavir drug combination; D061466:Lopinavir; D019259:Lamivudine; D000068898:Raltegravir Potassium; D015215:Zidovudine; D019438:Ritonavir