Síndrome de sensibilidad retardada a fármacos
Delayed drug sensitivity
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Hospital Severo Ochoa. Leganés (Madrid)." "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Delayed drug sensitivity" ] ] "textoCompleto" => "<p class="elsevierStylePara">Sr. Director:</p><p class="elsevierStylePara">Hemos leído con atención el artículo de Pérez Pimiento et al sobre el síndrome de hipersensibilidad retardada a fármacos, publicado en su revista en el número de junio de este año<span class="elsevierStyleSup">1</span>. Aun sabiendo que la lista de fármacos causales no pretendía ser exhaustiva, queremos destacar la importancia de las reacciones que ocurren entre los pacientes infectados por el virus de la inmunodeficiencia humana (VIH) con tratamiento antirretrovírico de gran actividad (TARGA)<span class="elsevierStyleSup">2</span>, habiéndose descrito reacciones con abacavir<span class="elsevierStyleSup">3</span>, efavirenz<span class="elsevierStyleSup">4</span>, zidovudina<span class="elsevierStyleSup">5</span>, didanosina<span class="elsevierStyleSup">6</span>, zalcitabina<span class="elsevierStyleSup">7</span>, delavirdina<span class="elsevierStyleSup">8</span>, nevirapina<span class="elsevierStyleSup">9</span> y amprenavir<span class="elsevierStyleSup">10</span>.</p><p class="elsevierStylePara">La alteración de la inmunidad celular presente en los pacientes infectados por VIH parece provocar una mayor susceptibilidad a este tipo de reacciones. Uno de los fármacos más representativos de este grupo es el abacavir; la incidencia de la reacción de hipersensibilidad se ha estimado en alrededor de un 4%<span class="elsevierStyleSup">11</span>, de los que cerca del 90% ocurren en las primeras 6 semanas del inicio de la medicación<span class="elsevierStyleSup">12</span>. La gravedad del cuadro es muy variable, empeorando con la administración continuada del medicamento tras el inicio de la reacción. Aunque se han descrito casos fatales<span class="elsevierStyleSup">13</span>, la totalidad de los casos son reversibles si se interrumpe la medicación antes de instaurarse la hipotensión. Presentamos un caso clínico para ilustrar esta entidad.</p><p class="elsevierStylePara">Se trata de un varón de 37 años de edad, VIH positivo, estadio B3, carga vírica 5,1 log<span class="elsevierStyleInf">10</span>, CD4: 224 cél/mm<span class="elsevierStyleSup">3</span> que a los 7 días de añadir a su tratamiento antirretrovírico previo (didanosina, estavudina y efavirenz) abacavir, presenta fiebre de hasta 40° C, mialgias generalizadas, astenia, disnea, eritrodermia, odinofagia, poliadenopatías y mucositis. En la analítica destacaban: triglicéridos, 931; GOT, 148; GPT, 200; LDH, 1.755; GGT, 717; fosfatasa alcalina, 299; plaquetas, 108.000, y linfocitos atípicos en el frotis. Los hemocultivos resultaron estériles, la radiografía de tórax no presentó alteraciones y la punción-aspiración con aguja fina (PAAF) de las adenopatías reveló cambios inflamatorios reactivos inespecíficos. Al ingreso se procedió a la retirada de los antirretrovíricos y se inició tratamiento esteroideo con desaparición de la fiebre y regresión del cuadro.</p><p class="elsevierStylePara">Nos ha parecido interesante destacar esta asociación por su relativa frecuencia y la importancia de su pronto reconocimiento, para evitar una mayor morbilidad al continuar el tratamiento y la necesidad de no volver a reintroducir la medicación por la posibilidad de desencadenar una reacción potencialmente mortal.</p>" "pdfFichero" => "65v230n12a13053740pdf001.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:13 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:3 [ "titulo" => "Síndrome de sensibilidad retardada a fármacos." 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ISSN: 00142565Original language: Spanish
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