Gill J, Wilson P, Farmer D, Oster W, Habboubi N; International Conference on AIDS.
Int Conf AIDS. 1996 Jul 7-12; 11: 317 (abstract no. Tu.B.2299).
USB Pharma Ltd, Croxley Green, England, UK.
Objective: Neutrexin is a potent inhibitor of P. carinii dihydrofolate reductase and has been shown to be of benefit in the management of pneumocystii carinii pneumonia. (PCP). It has shown significant activity in both untreated patients and those intolerant or refractory to the first line treatment of PCP, trimethoprim/sulphamethoxazole (TMP/SMX). We present here the first case report of an HIV-positive patient who received neutrexin to treat pneumocystis carinii (PC) choroiditis. Methods: The patient was HIV-positive for nine years, first presented with an AIDS defining illness in February 1994 with low CD4 counts, recurrent episodes of PCP, chronic hepatitis B, chronic pancreatitis and chronic obstructive airways disease. Patient was treated for PCP with TMP/SMX, pentamidine and was subsequently receiving prophylaxis for PCP namely pentamidine nebuliser and dapsone. On a follow-up visit in January 1995 the patient had normal eye history, with normal visual acuity in both eyes of 6/6 until May 1995 when the patient experienced flashing lights in the left eye and words jumping in the right eye. The ophthalmic investigations revealed the visual acuity in both eyes was 6/6. Funduscopy with the fundus photography of the right eye indicated a mottled appearance of the macula. The optic disc, blood vessels and peripheral retina zone 2 and 3 were normal. In the left eye the funduscopy with fundus photography revealed well-circumscribed yellow, slightly elevated chorioretinal lesions typical of PC choroiditis. Diagnosis of PC choroiditis was made on the basis of ophthalmic investigations. No other pathogens were identified in the lung with the eye as the only organ of disease involvement. The patient started neutrexin treatment in May 1995 at 45mg/m2 I.V. daily for 28 days followed by folinic acid I.V. for rescue at 20mg/m2 given q6hx4 for 31 days. Results: Patient completed therapy in June 1995 with no serious side effects to neutrexin. On September 1995 further opthalmoscopy and fundus photography revealed that the yellow elevated choroidal lesions had disappeared and PC choroiditis had resolved. Conclusions: This case report demonstrates that neutrexin was highly effective in treating PC Choroiditis in a patient with AIDS and augments the role of neutrexin treatment in extra pulmonary manifestations with pneumocystis carinii.
Publication Types:
Keywords:
- Acquired Immunodeficiency Syndrome
- CD4 Lymphocyte Count
- Chorioretinitis
- Choroiditis
- Dapsone
- Drug Combinations
- HIV Seropositivity
- Humans
- Pentamidine
- Pneumonia, Pneumocystis
- Trimethoprim-Sulfamethoxazole Combination
- Trimetrexate
- therapy
- trimetrexate glucuronate
Other ID:
UI: 102218400
From Meeting Abstracts