Reply to Angel-Moreno and Perez-Arellano

作者：Amy B. Garlin, Paul E. Sax · 发表于：Clinical Infectious Diseases · 年份：2006 · DOI：10.1086/500271 · 被引用次数：2 · 研究领域：Sepsis Diagnosis and Treatment、Cardiac and Coronary Surgery Techniques、Infective Endocarditis Diagnosis and Management

Sir—In response to the letter by Angel-Moreno and Perez-Arellano [1] regarding our recent article [2], we agree that our case represents an exceedingly uncommon and morbid chain of events after discontinuation of antiretroviral therapy (ART). However, we did, in fact, conduct an exhaustive search for other unifying diagnoses, although limitations on the length of the article made it impossible to report every negative study result that was noted during our patient's long, complex hospitalization. This patient never had significantly elevated lactate levels, although we, too, suspected mitochondrial toxicity caused by ART. He had transthoracic and transesophageal echocardiographs that did not show either signs of infective endocarditis or myocardial dysfunction consistent with infarction. We performed many blood cultures that revealed no growth of mycobacterial and fungal isolators. Several abdominal CTs showed no significant abnormalities and no evidence of hepatic steatosis; no signs of lymphoma or other malignancies were found either during cytological examination or during consultation with our oncology service. This patient had many concomitant medical problems, including hepatitis C virus infection and diabetes mellitus, and he was a cigarette smoker; these, as well as cumulative drug toxicity, may very well have played roles in the cascade of events that led to death. His hypercoagulability may have preceded retroviral rebound syndrome, or it may have been triggered by ...