Sepsis Mimicker in an Human Immunodeficiency Virus-Infected Patient

Area of Science:

• Clinical Medicine
• Pharmacology
• Infectious Diseases

Background:

• Antiretroviral therapy (ART) is essential for managing human immunodeficiency virus (HIV) infection.
• Efavirenz is a commonly used non-nucleoside reverse transcriptase inhibitor in first-line ART regimens.
• Hypersensitivity reactions to antiretroviral drugs, though uncommon, can be severe and life-threatening.

Observation:

• A 22-year-old male with HIV developed fever, rash, hypotension, and renal insufficiency.
• These symptoms emerged 18 days after starting an efavirenz-based ART regimen.
• The patient's presentation suggested a potential severe hypersensitivity reaction.

Findings:

• While rash is a known efavirenz side effect, severe systemic hypersensitivity is rare.
• Such reactions can manifest with multi-organ involvement, including hepatic toxicity and pneumonitis.
• In severe cases, these reactions have been associated with mortality.

Implications:

• Early recognition and diagnosis of efavirenz hypersensitivity are critical for patient outcomes.
• Corticosteroids are the primary therapeutic intervention for managing severe hypersensitivity reactions.
• This case highlights the importance of monitoring for rare but serious adverse events during ART initiation.