Acute and severe ribavirin-associated hyperuricemia and acute kidney injury: An underrecognized adverse effect

Abstract

Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose To report a case of ribavirin-associated severe hyperuricemia in an immunocompromised patient treated for respiratory syncytial virus (RSV) infection. Summary A 21-year-old male with a past medical history of B-cell acute lymphoblastic leukemia was in full remission after allogenic bone marrow transplantation complicated with chronic graft-versus-host disease. He was hospitalized due to fever, malaise, and respiratory syndromes. A diagnosis of RSV upper respiratory tract infection complicated by secondary pneumonia was made, and oral ribavirin (600 mg in 3 divided doses daily) and intravenous levofloxacin (750 mg once daily) were initiated. On day 2 of the hospital admission, the patient’s uric acid levels had increased from a baseline of 4 to 6 mg/dL to values of 19.3 and 22.2 mg/dL after the fourth and fifth doses of ribavirin, respectively, and his serum creatinine steadily had increased from a baseline of 0.7 to 0.8 mg/dL to a value of 1.6 mg/dL. Ribavirin was discontinued after the sixth dose, and a single dose of intravenous rasburicase (7.5 mg) was administered. On day 3, the patient’s serum uric and creatinine concentrations had decreased to 4.7 mg/dL and 1.1 mg/dL, respectively. He continued to recover on antibiotics and was discharged with normal uric acid and serum creatinine levels. Conclusion We report a case of severe hyperuricemia and acute kidney injury that developed early after initiation of ribavirin for RSV infection and suspected bacterial pneumonia in an immunocompromised patient without hepatitis C, requiring ribavirin discontinuation and rasburicase administration. To our knowledge, this is the first reported case of severe hyperuricemia in a patient treated with ribavirin for RSV infection rather than chronic hepatitis C. Clinicians should be aware of the possibility of acute and severe hyperuricemia following ribavirin administration.

Infection of Severe Fever with Thrombocytopenia Syndrome Virus as a Cause of a Child’s Fever of Unknown Origin: A Case Report

“… 15 They are not recommended for usage during pregnancy due to their teratogenic and mutagenic properties. 16 …”

“…15 They are not recommended for usage during pregnancy due to their teratogenic and mutagenic properties. 16 There are no studies reported that particularly assess the effectiveness of ribavirin in pediatric patients of SFTS. More research is imperative to ascertain the best ribavirin dose, course, and pathway of administration in children suffering from SFTS.…”

Antiviral Treatment Options for Severe Fever with Thrombocytopenia Syndrome Infections

“…Bone marrow suppression can cause reversible dose-dependent hemolytic anemia and increase plasma uric acid, iron, and bilirubin levels [ 18 ]. They are not recommended for usage during pregnancy because of their teratogenic and mutagenic properties [ 19 ].…”

A survey on acute kidney injury in severely and critically ill COVID-19 patients without chronic kidney disease

“…For the patients in our study, arbidol, ribavirin, and oseltamivir were used as antiviral therapies. To date, there have been no reports on arbidol-or oseltamivir-induced AKI, and only 1 study has reported severe hyperuricemia and AKI developing early after the initiation of ribavirin for respiratory syncytial virus infection (19). Therefore, the correlation between ribavirin and AKI is unclear.…”