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TEACHING FILES (GRAND ROUNDS)
 
   
 
 
Title : Rash
 
Author Details : Ira Shah
Medical Sciences Department, Pediatric Oncall, Mumbai

Address for Correspondence: Dr Ira Shah, 1, B Saguna, 271, B St Francis Road, Vile Parle {W}, Mumbai 400056. India
 
Clinical Problem : An 11 year old HIV infected girl on 3 drugs ART consisting of Zidovudine {AZT}, Lamivudine {3TC} and Efavirenz {EFV} since past 1 year presented with generalized swelling all over body with itching and rash since 5 days. She was given Nevirapine {NVP} instead of EFV by a local hospital 7 days ago. She also has NVP induced rash 1 year ago when she was first started on ART and hence shifted to EFV.
 
Question : What could be the cause of present problems_?
 
Expert Opinion : Since the child had skin rashes earlier with Nevirapine and now again has received NVP, one may very well assume that the present swelling and itching and rash could also be due to NVP. The swelling is suggestive of angioedema and rash and itching is suggestive of urticaria. In this child, blood counts demonstrated eosinophilia {absolute eosinophil count = 2,942 cells, cumm} and rash subsided with steroids and antihistaminics.

Thus, one must never restart NVP in a child who has already had allergic reactions to the same as these allergic reactions may be life threatening. Also, ideally if there is an allergic reaction to any one drug of the NNRTI group, one must avoid all drugs in that group. However, since the child could not afford protease inhibitors, we have put the child on Efavirenz and she is not having any problems with the same.

E-published: February 2011 Vol 8 Issue 2 Art No. 10
 
Funding : None
 
Conflict of Interest : None
 
DOI No. :
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