2016 年 42 巻 5 号 p. 373-380
Sulfamethoxazole / trimethoprim (ST) is the most effective prophylaxis and the first-line treatment for Pneumocystis jirovecii pneumonia (PCP). Adverse reactions such as rash or fever to ST are more frequent and severe in human immunodeficiency virus (HIV)-infected patients as compared to uninfected individuals. Intravenous pentamidine isethionate (PTM) is recommended for patients who cannot tolerate ST, and oral suspension of atovaquone (ATQ) is the third alternative agent. The most common adverse effects of alternative therapies include severe dysglycemia, diarrhea and leukopenia with PTM; and nausea, rash and headache with ATQ. Such reactions limit continuation of the treatment for PCP.
A 35-year-old HIV-infected female with PCP was given ST. She presented with systemic rash, fever, nausea and vomiting by ST. PTM was administered to her as an alternative agent. However, it was discontinued because of diarrhea, vomiting and leukopenia. Therefore, we gave her ATQ as the third alternative agent. However, it was discontinued because of systemic eruption with the itching. Although we resumed PTM, it was discontinued because of similar side effects to the initial administration. We chose ATQ that had fewer side effects than others, and tried desensitization. It was successful and secondary prophylaxis of PCP was also possible.
This case suggests a likelihood that desensitization to ATQ can be beneficial for the patients suffering from the treatment and prevention of HIV-related PCP by the adverse events due to ST, PTM and ATQ.