Acute fibrinous and organizing pneumonia as a rare presentation of abacavir hypersensitivity reaction

• Published in: AIDS (London) Vol. 21; no. 15; pp. 2116 - 2117
• Main Authors: YOKOGAWA, Naoto, ALCID, David V
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01-10-2007
• Subjects: Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiviral agents; Biological and medical sciences; Dideoxynucleosides - immunology; Drug Hypersensitivity - diagnosis; Female; Fibrin; HIV Infections - drug therapy; Human immunodeficiency virus; Human viral diseases; Humans; Infectious diseases; Lung - pathology; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Pneumonia - diagnosis; Reverse Transcriptase Inhibitors - immunology; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Lung disease; Purine nucleoside; Antiretroviral agent; Pneumonia; RNA-directed DNA polymerase; Respiratory disease; Enzyme; Toxicity; Transferases; Acute; Hypersensitivity; Enzyme inhibitor; Nucleotidyltransferases; Reverse transcriptase inhibitor; Abacavir; Nucleoside analog; Antiviral
• ISSN: 0269-9370; 1473-5571
• DOI: 10.1097/QAD.0b013e3282f08c5a

Abacavir, an HIV nucleoside analogue reverse transcriptase inhibitor, can cause hypersensitivity reactions in 3-5% of patients started on the drug, and 90% of cases occur within the first 6 weeks after initiation (median time 11 days). The most common symptoms of abacavir hypersensitivity are fever, rash, and gastrointestinal symptoms. Respiratory symptoms such as dyspnea, cough, and pharyngitis are prominent in 30% of cases and mimic pneumonia. Characteristically, symptoms appear suddenly and worsen over just a few days when the use of abacavir is continued. Very rarely hypotension, renal insufficiency, and bronchoconstriction have resulted in death, especially after the rechallenge of the drug. If the use of abacavir is discontinued in time to prevent the development of hypotension, the hypersensitivity reaction resolves completely in a few days. Herring and Krieger recently reported a patient with fulminant pneumonitis leading to acute respiratory syndrome (ARDS) after 11 days of therapy with abacavir. ARDS resolved within 3 days after the discontinuation of abacavir. The lung tissue was not available in that report.