[Intolerance to trimethoprim-sulfamethoxazole in Pneumocystis carinii pneumonia in AIDS. Search for predictive factors]. / Intolérance au triméthoprime-sulfaméthoxazole au cours de la pneumocystose pulmonaire du SIDA. Recherche de facteurs prédictifs.

The treatment and the prevention of Pneumocystis carinii pneumonia (PCP) is based on trimethoprim-sulfamethoxazole. However, hypersensitivity reactions occur often in HIV-infected patients. In this study, clinical and biological parameters of 27 PCP-patients treated by this drug association were analyzed. We divided the drug reactions into two groups according to the severity. A drug reaction occurred in 59.2% of the patients and was note as a mild reaction in 18.5% of the cases and as a severe reaction in 40.7%. An initial high eosinophil count was noted in patients who may present future drug reaction. This difference was more significant in patients who may present severe drug reaction. No other clinical or biological factors were predictive of hypersensitivity. The immune status of HIV-disease, drug therapy, and drug mechanisms were discussed.

[Portal hypertension and hypervitaminosis A. Apropos of 2 cases and review of the literature]. / Hypertension portale et hypervitaminose A. A propos de deux cas et revue de la littérature.

Portal hypertension consecutive to hypervitaminosis A has seldom been well documented. Two cases are reported here. The first case concerns a 39-year old woman who had taken meladinine (8-methoxypsoralen) for the purpose of tanning. In the second case, a 43-year old woman had absorbed Plethoryl (a combination of tiratricol, cyclovalone and retinol) in order to lose weight. Both patients had histological hepatic lesions, such as hypertrophic Ito cells, perisinusoidal cirrhosis and spontaneous autofluorescence, suggestive of vitamin A overload, associated with a hepatic vein pressure gradient of 10 mmHg or more and high liver concentrations of vitamin A. The responsibility of Plethoryl in case 2 is beyond any doubt, but the mechanism of hypervitaminosis in case 1 is controverted. A review of the literature has provided detailed information on the signs of vitamin A overload, the frequency of which is probably underestimated. Patients with portal hypertension of unknown origin should be investigated for hypervitaminosis A.