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. 2009:2009:bcr01.2009.1411.
doi: 10.1136/bcr.01.2009.1411. Epub 2009 Jun 15.

Severe myositis on commencement of efavirenz, abacavir and lamivudine, in the absence of lactic acidosis or classical abacavir hypersensitivity

Mirella Jane Parsonage  1 , Gavin Barlow, Patrick Lillie, Peter Moss, Katherine Adams, Hiten Thaker
Affiliations

Severe myositis on commencement of efavirenz, abacavir and lamivudine, in the absence of lactic acidosis or classical abacavir hypersensitivity

Mirella Jane Parsonage et al. BMJ Case Rep. 2009.

Abstract

Myositis in HIV may be due to HIV itself, or to opportunistic infection, malignancy or drug treatment. Severe myositis or rhabdomyolysis have never been reported with the commonly used nucleoside reverse transcriptase inhibitor abacavir, although creatine phosphokinase may rise modestly, particularly if abacavir hypersensitivity occurs. We report an unusual case of abacavir use associated with a thousand-fold rise in creatine phosphokinase in the absence of features of hypersensitivity. The case was also notable firstly in that there was an absence of the HLA-B5701 allele, the most common human leucocyte antigen (HLA) allele associated with hypersensitivity, and, secondly, as the case occurred in an African patient, African people not being prone to abacavir hypersensitivity.

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Figures

Figure 1
Figure 1
Variation of serum creatine phosphokinase with time elapsed since onset of antiretroviral treatment.
Figure 2
Figure 2
Variation of serum alanine aminotransferase with time elapsed since onset of antiretroviral treatment.
See this image and copyright information in PMC

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