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M9650345.TXT
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1996-03-09
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Document 0345
DOCN M9650345
TI Subacute mitochondrial liver disease in a patient with AIDS: possible
relationship to prolonged fluconazole administration.
DT 9605
AU Guillaume MP; De Prez C; Cogan E; Department of Internal Medicine,
Hopital Universitaire Brugmann,; Belgium.
SO Am J Gastroenterol. 1996 Jan;91(1):165-8. Unique Identifier : AIDSLINE
MED/96145309
AB Azole-derived antifungal medications are particularly involved in
drug-induced hepatic injury encountered in patients with AIDS.
Fluconazole may induce multiple hepatic abnormalities usually
characterized by asymptomatic and reversible mild hepatic necrosis. We
here describe severe subacute liver damage occurring in a patient with
AIDS who was receiving fluconazole maintenance therapy for a
cryptococcosis. Hepatotoxicity was essentially characterized by mixed
cytolytic and cholestatic liver tests abnormalities which improved after
fluconazole discontinuation and worsened on fluconazole rechallenge.
Optical microscopy demonstrated nonspecific abnormalities including
granular aspect of the cytoplasm of the hepatocytes. In contrast,
analysis of electron microscopy revealed unusual unreported features
characterized by giant mitochondria with paracrystalline inclusions and
enlarged smooth endoplasmic reticulum. All microscopic abnormalities
were reversed after discontinuation of fluconazole. We suggest that
persistent increased hepatic enzymes in HIV-infected patient taking
fluconazole should prompt suspension of the treatment. Prospective
studies are needed to determine whether careful monitoring of hepatic
tests should be recommended in AIDS patients on prolonged fluconazole
maintenance therapy.
DE Acquired Immunodeficiency Syndrome/*COMPLICATIONS/PATHOLOGY Acute
Disease Adult Antifungal Agents/ADMINISTRATION & DOSAGE/*ADVERSE
EFFECTS AIDS-Related Opportunistic Infections/COMPLICATIONS/DRUG
THERAPY Biopsy Case Report Cryptococcosis/COMPLICATIONS/DRUG THERAPY
Female Fluconazole/ADMINISTRATION & DOSAGE/*ADVERSE EFFECTS Hepatitis,
Toxic/*ETIOLOGY/PATHOLOGY Human *HIV-1 Lung Diseases,
Fungal/COMPLICATIONS/DRUG THERAPY Mitochondria, Liver/*DRUG
EFFECTS/ULTRASTRUCTURE Time Factors JOURNAL ARTICLE REVIEW REVIEW OF
REPORTED CASES
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).