Didanosine-Associated Eosinophilia with Acute Thrombocytopenia

Abstract

French

OBJECTIVE:

To report a case of didanosine (ddI)-induced acute thrombocytopenia and to discuss the incidence of this occurrence.

CASE SUMMARY:

A 42-year-old man was admitted to the hospital on November 21, 1991, with acute thrombocytopenia. The patient had an AIDS index diagnosis of Kaposi's sarcoma (KS) in 1988 and had been taking zidovudine (ZDV) for three years without any adverse effects. On July 26, 1991, he complained of increasing fatigue and weight loss. At that time, the therapy was changed from ZDV to ddI. Over the next four months the drug therapy was altered from ddI to ZDV and ZDV to ddI because of increasing fatigue and gastrointestinal symptomatology; all of the other chronic medications were maintained at the same dosages and frequency. All laboratory work remained stable and no new active processes were found during this period. The patient developed acute thrombocytopenia upon his last change to ddI and all of the chronic drug therapy was stopped. His platelet count returned to his baseline value three weeks after the discontinuation of ddI and reinstitution of his chronic medications.

DISCUSSION:

A review of the literature showed two documented cases of thrombocytopenia with ddI on a dosage escalation study.

CONCLUSIONS:

Close patient monitoring is essential while administering ddI.

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References

Cooley

Kunches

Saunders

Perkins

Kelley

McLaren

. Treatment of AIDS-related complex with 2′,3′-dideoxyinosine given once daily. Rev Infect Dis 1990; 12 (suppl):S552–60.

Dolin

Lambert

Morse

Reichman

Plank

Reid

. 2′,3′-Dideoxyinosine in patients with AIDS or AIDS-related complex. Rev Infect Dis 1990; 12 (suppl):S540–51.

Dornsife

Clair

Huang

Panella

Koszalka

Burns

. Anti-human immunodeficiency virus synergism by zidovudine (3′-azidothymidine) and didanosine (dideoxyinosine) contrasts with their additive inhibition of normal human marrow progenitor cells. Antimicrob Agents Chemother 1991; 35: 322–8.

McEvoy

, ed. American hospital formulary service (AHFS) drug information 1991. Bethesda, MD: American Society of Hospital Pharmacists, 1991: 367,397.

Product information. Zovirax (acyclovir). Research Triangle Park, NC: Burroughs Wellcome, 1991.

Product information. Retrovir (zidovudine). Research Triangle Park, NC: Burroughs Wellcome, 1991.

The Swiss Group for Clinical Studies on the Acquired Immunodeficiency Syndrome. Zidovudine for the treatment of thrombocytopenia. Ann Intern Med 1988; 109: 718–21.

Pottage

Benson

Spear

. Treatment of human immunodeficiency virus-related thrombocytopenia with zidovudine. JAMA 1988; 260: 3045–8.

Salem

Terebelo

Raman

. Human immunodeficiency virus associated with thrombotic thrombocytopenia purpura: Successful treatment with zidovudine. South Med J 1991; 84: 493–5.

10.

Abrams

Lewis

Beckstead

Casavant

Drew

. Persistent diffuse lymphandenopathy in homosexual men: Endpoint or prodrome? Ann Intern Med 1984; 100: 801–8.

11.

Murphy

Metcalf

Walters

Carne

Weller

Linch

. Incidence and mechanism of neutropenia and thrombocytopenia in patients with human immunodeficiency virus infection. Br J Haematol 1987; 66: 337–40.

12.

Stricker

. Hemostatic abnormalities in HIV disease. Hematol Oncol Clin N Am 1991; 5: 249–65.

13.

Walsh

Krigel

Lennette

Karpatkin

. Thrombocytopenia in homosexual patients. Prognosis, response to therapy, and prevalence of antibody to the retrovirus associated with the acquired immunodeficiency syndrome. Ann Intern Med 1985; 103: 542–5.

14.

Aboulafia

Mitsuyasu

. Hematologic abnormalities in AIDS. Hematol Oncol Clin North Am 1991; 5: 195–214.

15.

Richman

Fischl

Grieco

Gottlieb

Volberding

Laskin

. The toxicity of azidothymidine (AZT) in the treatment of patients with AIDS and AIDS-related complex. A double-blind placebo-controlled trial. N Engl J Med 1987; 317: 192–7.

16.