Force Gilles , Blanchard A, Leviel F, Tugler MH, Champetier de Ribes D; International Conference on AIDS.
Int Conf AIDS. 1996 Jul 7-12; 11: 87 (abstract no. Mo.B.1190).
Hopital du Perpetuel Secours, Levallois-Perret, France. Fax: (33) 1 47 59 59 60.
Introduction: Nephrogenic diabetes insipidus (NDI) is known to occur as a rare complication of several drugs. An AIDS patient with CMV disease developed NDI with foscarnet (PFA) therapy. A relative thirst loss was associated. Case record: A 43-year-old african HIV-infected woman was evaluated for polydipsia and polyuria. Six weeks before, CMV retinitis was diagnosed and therapy with PFA begun at doses of 80mg/kg every 12 hours with 1L of normal saline; chronic lumbar pain was documented and CMV DNA was identified using PCR in the cerebrospinal fluid (CSF). The CD4 count was 4 x 106/L. There was no hypercalcemia and no hyperglycemia. PFA was stopped and the symptoms were resolved after 3 weeks. Serum and clinical data were done before PFA (A), after 6 weeks of PFA (B), after the water deprivation test (C), after nasal spray of 2 x10-4L aqueous vasopressin (V) and free regime in water (D), and 3 weeks after PFA stop (E): (table: see text) Discussion and conclusion: Dehydration (D) demonstrated by hypernatremia and a 2.9% weight loss, was associated with a low urine osmolality not increased by exogenous V. This response to V, and the appropriately elevated level of endogenous V at 14.8 x10-12g/L, are consistent with the diagnosis of NDI, associated temporally with the use of PFA, but the mechanisms by which PFA induces NDI in the collecting duct are unclear. In the use of PFA, we recommand to look for natremia and polyuria, to detect early NDI. With a free regime in water, we observed no sensation of thirst despite elevated plasma osmolality and natremia; a lesion of thirst center in the central nervous system (CNS) was suspected and CMV was incriminated because the presence of CMV in the CSF is correlated with CMV disease of the CNS. The D was increased by thirst loss probably related to CMV encephalitis.
Publication Types:
Keywords:
- Acquired Immunodeficiency Syndrome
- Cytomegalovirus Retinitis
- Diabetes Insipidus, Nephrogenic
- Encephalitis
- Female
- Foscarnet
- Humans
- Hypernatremia
- Polyuria
- Thirst
- Vasopressins
Other ID:
UI: 102217154
From Meeting Abstracts