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Hyperlactataemia and hepatic steatosis: mitochondrial toxicity of nucleoside reverse transcriptase inhibitors
  1. D Pao1,
  2. C Watson1,
  3. B Peters1,
  4. S B Lucas2,
  5. R F Miller3
  1. 1Academic Department of Genitourinary Medicine
  2. 2Department of Histopathology, Guy's, King's and St Thomas's School of Medicine, St Thomas's Hospital, London SE1 7EH, UK
  3. 3Department of Sexually Transmitted Diseases, Windeyer Institute of Medical Sciences, Royal Free and University College Medical School, University College London, and Mortimer Market Centre, Camden and Islington Community Health Services NHS Trust, London WC1E 6AU, UK
  1. Dr RF Miller rmiller{at}gum.ucl.ac.uk
  1. This case was presented on 20 April 2001 at the Royal Society of Medicine during a meeting of the Medical Society for the Study of Venereal Diseases. On that occasion, the case was presented by Dr B Peters and the “blind” discussant was Dr R Miller.

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Case presentation (Dr B Peters)

A 40 year old heterosexual black African man presented to the accident and emergency department with a 4 minute episode of loss of consciousness with associated incontinence. On inquiry, he gave a 1 month's history of left sided headache, weight loss, fever, and a right axillary swelling. He had a medical history of recurrent malaria, typhoid as a child, drainage of groin abscess in 1999, and severe acne. An HIV antibody test had been negative in 1993. On admission he was taking ciprofloxacin 500 mg twice daily, prescribed by a primary care physician as treatment for the axillary infection; he had recently completed a course of isotretinoin as treatment for acne. He worked as a delivery driver, drank no alcohol, and was a non-smoker. He had been resident in the United Kingdom for 7 years.

On examination he was pyrexial, temperature 38.5°C, had oral candida, severe acne, and a 4 cm diameter infected sebaceous cyst in the right axilla. There was no lymphadenopathy and examination of the respiratory, cardiovascular, abdominal, and nervous systems was normal.

Investigations on admission to hospital included a computed tomograph (CT) scan of the head (with contrast) which showed a single ring enhancing lesion in the left basal ganglia with surrounding oedema and mid-line shift. A diagnosis of cerebral toxoplasmosis was made. Subsequently, an FDG PET (positron emission tomography) scan and cranial magnetic resonance image (MRI) supported this diagnosis. Other investigations showed HIV-1 antibodies detected, cytomegalovirus IgG positive, DAT negative, Toxoplasma gondii IgG > 1:1024, serum cryptococcal latex agglutination (CRAG) …

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