Reactions 856 - 16 Jun 2001

Probenecid

Hypersensitivity: case reportA 34-year-old man developed a hypersensitivity reaction

with sepsis-like symptoms after receiving probenecid.The man had HIV infection and valaciclovir- and aciclovir-

resistant genital and perianal herpes treated with cidofovir. Hereceived probenecid twice weekly to counteract cidofovir-associated nephrotoxicity. He tolerated this treatment[duration of treatment not stated] until he developed a fever of102°C, chills, rigours, tachycardia, nasal congestion andswelling of his face. These symptoms developed 30 minutesafter taking cidofovir, which he had taken several hours afterprobenecid 3g. He was treated with antibacterials, and hissymptoms improved.

A drug reaction to cidofovir was suspected and the manreceived alternative antivirals over the next 3 months, but theywere unsuccessful. He was then challenged with probenecid1g on its own. Six hours later, he developed chills, rigours andtachycardia, and then fever, hypotension and oxygendesaturation. He was treated with supportive measures and herecovered. His herpes infection was then treated withcidofovir, combined with an alternative uricosuric. He did notexperience any further symptoms of hypersensitivity.

Author comment: ‘When a patient develops SIRS [systemicinflammatory response syndrome], a pseudosepsis drughypersensitivity reaction should be seriously considered.’Loesevitz AW, et al. Probenicid-related drug hypersensitivity reaction presentingas a sepsis-like syndrome (systemic inflammatory response syndrome - SIRS).Annals of Allergy, Asthma and Immunology 86: 78, Jan 2001 [abstract] -USA 800864289

1

Reactions 16 Jun 2001 No. 8560114-9954/10/0856-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved