Paronychia and Pyogenic Granuloma of the Great Toes in Patients Treated with Indinavir

Bouscarat, F.; Bouchard, Cécile; Bouhour, D.

doi:10.1056/nejm199806113382417

Cited by 104 publications

(42 citation statements)

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“…It has already been mentioned in the recent reports on paronychia and pyogenic granuloma, observed during therapy of adult patients with IDV [4, 5, 6], that similar symptoms have also been seen during systemic treatment with oral retinoids, such as etretinate, its nonesterified derivative acitretin or isotretinoin [8, 9, 10, 11, 12]. Based on homologies of the amino acid sequences of the HIV-1 protease and cytoplasmic retinoic-acid-binding protein type 1 (CRABP-1), Carr et al [2]have proposed that HIV-1-protease-inhibitor-associated peripheral lipodystrophy represents a consequence of impaired retinoid metabolism due to protease inhibitor effects.…”

Section: Discussionmentioning

confidence: 97%

“…None of the 3 other children who receive protease inhibitor treatment in our department showed such symptoms. Bouscarat et al [4]first reported paronychia in 42 adults, representing 4% of their patients receiving IDV.…”

Section: Discussionmentioning

confidence: 99%

“…Based on homologies of the amino acid sequences of the HIV-1 protease and cytoplasmic retinoic-acid-binding protein type 1 (CRABP-1), Carr et al [2]have proposed that HIV-1-protease-inhibitor-associated peripheral lipodystrophy represents a consequence of impaired retinoid metabolism due to protease inhibitor effects. Several authors have subsequently referred to that proposal [4, 5, 6, 13]. While several aspects do support interferences between IDV and retinoid metabolism, the concept of Carr et al [2]deserves some reconsideration, as it is partly based on wrong assumptions and therefore misleading.…”

Section: Discussionmentioning

confidence: 99%

“…1). Surgical treatment of IDV-associated paronychia was reported [4]and was performed without relapse in 4 adult patients in our center but was not done in this case. At month 28 on triple therapy, IDV was switched to nelfinavir (2×1,250 mg/day) because the patient suffered from the food restrictions necessary for optimal IDV absorption.…”

Section: Case Reportmentioning

confidence: 99%

“…The clinical use of protease inhibitors is complicated by a variety of interactions with other drugs, for instance because of joint pathways via the cytochrome P450 3A4 enzyme [1]. Recently, reports have addressed paronychia and ingrown nails on the great toes of (adult) patients infected with HIV-1 (the majority of them having AIDS) treated with the HIV-1 protease inhibitor indinavir (IDV) [4, 5, 6]. We now report on the first pediatric patient presenting with such symptoms of a great toe.…”

Section: Introductionmentioning

confidence: 99%

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Paronychia with Pyogenic Granuloma in a Child Treated with Indinavir: The Retinoid-Mediated Side Effect Theory Revisited

Sass

Jakob-Sölder²,

Heitger

et al. 2000

Dermatology

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Background: The introduction of HIV-1 protease inhibitors into the treatment of patients infected with HIV-1 has had a major influence on clinical practice. However, the use of protease inhibitors is frequently associated with the development of resistance and several side effects and interactions with other drugs have been reported. Observations: We present the first pediatric patient with paronychia with pyogenic granuloma associated with the administration of the protease inhibitor indinavir. Clinical findings are discussed in view of a possible interference of indinavir with endogenous retinoid metabolism. Conclusion: Considerable evidence advocates the mediation of indinavir side effects by impaired oxidative metabolism of retinoic acid through the inhibition of cytochromes P450 3A by indinavir rather than by impaired formation of 9-cis-retinoic acid.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Case Reportmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Paronychia with Pyogenic Granuloma in a Child Treated with Indinavir: The Retinoid-Mediated Side Effect Theory Revisited

Sass

Jakob-Sölder²,

Heitger

et al. 2000

Dermatology

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The Changing Spectrum of the Cutaneous Manifestation of HIV Disease

Colebunders¹,

Vandenbruaene²

1999

Archives of Dermatology

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Developmental toxicity of the HIV-protease inhibitor indinavir in rats

et al. 2000

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Background Indinavir is an antiviral agent used for the treatment of HIV infection. We studied its developmental toxicity in rats. Methods Pregnant animals were treated orally with 500 mg indinavir/kg body weight (bw) from day 6 to 15 of gestation (once daily) or from day 9 to 11 (twice daily). Fetuses were evaluated for external and skeletal anomalies on day 21 of gestation. In addition, 19 rats were treated from day 9 of gestation to day 24 postnatally with 500 mg indinavir/kg bw once daily; a control group of 17 rats was treated with the vehicle accordingly. Developmental landmarks were recorded. Sixteen offspring each were studied on postnatal days 7, 14, 21, and 35 for hepatic enzyme activity. Liver tissue was examined by electron microscopy. Results Fetal examination on day 21 of pregnancy showed no treatment‐related effects on number, weight, and viability of the fetuses; however, an increased incidence was noted in the supernumerary ribs and variations of the vertebral ossification centers in both indinavir‐treated groups. Postnatal evaluation showed delayed fur development, eye opening, and descensus testis. The most striking finding was unilateral anophthalmia, observed in 7 pups (3%) from 2 out of 19 litters exposed to indinavir, but not in controls. Only minor changes in hepatic monooxygenase activities occurred in dams. Electron microscopy of liver samples showed hepatocellular inclusions of lipids and myelin figure‐like structures in maternal livers and infiltration with granulocytes in offspring livers. Conclusions Further studies on reproductive toxicity, including combinations of three or more antiretroviral agents as used therapeutically, are needed to determine the hazards of such a treatment. Teratology 62:291–300, 2000. © 2000 Wiley‐Liss, Inc.

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Paronychia and Pyogenic Granuloma of the Great Toes in Patients Treated with Indinavir

Cited by 104 publications

References 1 publication

Paronychia with Pyogenic Granuloma in a Child Treated with Indinavir: The Retinoid-Mediated Side Effect Theory Revisited

Paronychia with Pyogenic Granuloma in a Child Treated with Indinavir: The Retinoid-Mediated Side Effect Theory Revisited

The Changing Spectrum of the Cutaneous Manifestation of HIV Disease

Developmental toxicity of the HIV-protease inhibitor indinavir in rats

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