[Allergic hypersensitivity to antiretroviral drugs: etravirine, raltegravir and darunavir]. / Hipersensibilidad alérgica a antirretrovirales: etravirina, raltegravir y darunavir.

All antiretroviral drugs can have both short-term and long-term adverse events. The risk of specific side effects varies from drug to drug, from drug class to drug class, and from patient to patient. A better understanding of the adverse effects of antiretroviral agents is of interest not only for HIV specialists, but also for other physicians who care allergy reactions in HIV-positive patients. Each antiretroviral medication is associated with its own specific adverse effects or may cause problems only in particular circumstances. In this article some adverse allergic effects of HAART therapy in the treatment of HIV from a patient are reviewed. Our aim is to gain a working knowledge of these adverse effects, promoting the early recognition and reversal of potentially serious adverse effects, and reducing the potential for adverse drug interactions.

Todos los fármacos antirretrovirales tienen efectos adversos que pueden manifestarse a corto o largo plazo. El riesgo de efectos secundarios específicos varía de un fármaco a otro, de una clase de medicamento a otra y de un paciente a otro. Una mejor comprensión de estos efectos es de interés no sólo para los especialistas en VIH, sino también para otros médicos que atendemos las reacciones alérgicas en los pacientes VIH-positivos. Cada fármaco antirretroviral se asocia con sus propios efectos adversos específicos o puede causar problemas sólo en circunstancias particulares. En este artículo se revisan algunos efectos alérgicos adversos del tratamiento antirretroviral de gran actividad (TARGA) en el tratamiento del VIH de un paciente. Nuestro objetivo es obtener un conocimiento práctico de estos efectos adversos, promoviendo el reconocimiento temprano y la reversión de los efectos adversos graves y reducir las interacciones farmacológicas adversas.

[Cutaneous necrotic loxoscelism. A case report]. / Loxoscelismo cutáneo necrótico. Informe de un caso.

Brown recluse (Loxosceles spp.) spiders are arachnid species known to cause necrotic arachnidism. The envenomation, described as loxoscelism, is associated with localized pain, erythema, and edema followed by the development of necrosis. However, the specific pathophysiological mechanisms by which Loxosceles venom exerts these noxious symptoms are multifactorial and not fully understood. The causative factor for production of necrotic lesions is generally considered to be the enzyme sphingomyelinase D (SMD), which cleaves sphingomyelin to form choline and ceramide 1-phosphate. Four active forms of SMD with molecular weight of 32 000 are found in L recluse. Sphingomyelinases of comparable size are also described in the venoms of Loxosceles intermedia, gaucho and laeta. Here we describe the case of a young male adult who suffered a spider bite on his left forearm which evolved into a necrotic lesion, and after a few days the injury healed completely. One week later the patient developed two similar lesions on his left leg. The diagnosis was established by clinical data and by biopsy findings. The patient did not developed systemic complications.

[Hypersensitivity to metals in patients with orthopedic implants]. / Hipersensibilidad a metales en pacientes con implantes ortopédicos.

All metals in contact with biological systems suffer corrosion, which is an electrochemical process that causes metallic ions formation, known as haptens, which link with endogenous or exogenous proteins, therefore inducing an immune response. A hypersensitivity response to an implanted material should be suspected when cutaneous lesions or inflammatory reactions occur proximal to or surrounding the site of the metallic orthopedic implant. At present there is no a reliable diagnostic test for the determination of hypersensitivity to implanted metallic devices. It has been shown that the products of corrosive degradation are associated with dermatitis, urticaria and vasculitis. Cutaneous lesions in patients with unsuccessful metallic implants are more frequent than in non-rejected implants or the general population. Although the cellular and humoral hypersensitivity response in metallic orthopedic implants has been clearly identified, the risk is very low. Nowadays the importance of hypersensitivity to metals as a contributing factor in the failure of implants is unknown.