Case Report

Emtricitabine-induced pure red cell aplasia

Nithendra Manickchund, Camille du Plessis, Melanie-Anne A. John, Thandekile C. Manzini, Bernadett I. Gosnell, Richard J. Lessells, Yunus S. Moosa
Southern African Journal of HIV Medicine | Vol 20, No 1 | a983 | DOI: https://doi.org/10.4102/sajhivmed.v20i1.983 | © 2019 Yunus S. Moosa | This work is licensed under CC Attribution 4.0
Submitted: 10 May 2019 | Published: 23 September 2019

About the author(s)

Nithendra Manickchund, King Edward VIII Hospital, Durban, South Africa; and, Department of Infectious Diseases, University of KwaZulu-Natal, Durban, South Africa
Camille du Plessis, King Edward VIII Hospital, Durban, South Africa; and, Department of Infectious Diseases, University of KwaZulu-Natal, Durban, South Africa
Melanie-Anne A. John, Department of Infectious Diseases, University of KwaZulu-Natal, Durban, South Africa
Thandekile C. Manzini, Department of Infectious Diseases, University of KwaZulu-Natal, Durban, South Africa
Bernadett I. Gosnell, King Edward VIII Hospital, Durban, South Africa; and, Department of Infectious Diseases, University of KwaZulu-Natal, Durban, South Africa
Richard J. Lessells, Department of Infectious Diseases, University of KwaZulu-Natal, Durban, South Africa; and, KwaZulu-Natal Research and Innovation Sequencing Platform (KRISP), University of KwaZulu-Natal, Durban, South Africa; and, Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa
Yunus S. Moosa, King Edward VIII Hospital, Durban, South Africa; and, Department of Infectious Diseases, University of KwaZulu-Natal, Durban, South Africa


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Abstract

Introduction: Anemia is common in HIV. Parvo B19 infection is a well-recognised cause of red cell aplasia. Other causes of persistent pure red cell aplasia (PRCA) include anti-retroviral drugs such as zidovudine and lamivudine. We describe a case of PRCA that strongly implicates emtricitabine as the probable cause.

Patient presentation: Patient was HIV positive and on treatment with a fixed drug combination consisting of tenofovir, emtricitabine and efavirenz for 3 months when she developed severe transfusion dependent anemia. The anemia, attributed to PRCA, was persistent and transfusion dependent for about one year.

Management and outcome: Replacement of emtricitabine with abacavir resulted in a prompt, complete and lasting resolution of the anaemia, suggesting an etiologic role of emtricitabine in the PRCA.

Conclusion: Emtricitibine is a rare cause of pure red cell aplasia.


Keywords

emtricitabine; pure red cell aplasia; drug induced; rare drug toxicity; adverse drug reaction; antiretroviral

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