39-year-old woman with a history of human immunodeficiency virus (HIV) infection, on treatment with lopinavir boosted with ritonavir (LPV/r, kaletra®) and maraviroc (MRV, celsentripsy)
He was prescribed paracetamol 1g and metoclopramide 10mg in the emergency department.
A few hours later he was discharged due to improvement of symptoms.
Four days later, the patient came back to the emergency department complaining of paresthesia in the fingers of both hands and in the left upper limb (LUL), with sensation of loss of strength, intense coldness and c
Reinterrupting the patient reported that due to headache, she took two tablets of hemicraneal® (paracetamol 300mg, caffeine 100mg, ergotamine 1mg) presenting dizziness, feeling of instability.
Examination revealed absence of pulses in both upper limbs (MMSS).
In the analytical analysis, the result of fibrin degradation products was within the range: 282.70ng/ml (cure-500.0).
However, a pattern of chronic obstruction with abundant collateral circulation was observed in both upper and lower limbs on ultrasound examination.
She was diagnosed with arterial ischemia with vasospasm component in the upper limbs, thrombosis of arterial vessels and paresis in the lower limbs probably precipitated by drug interaction between PI (ritonavir) and ergotaminic derivatives.
She was admitted to the Vascular Surgery Department where antiretroviral treatment (LPV/r + MRV) was discontinued and started anticoagulation with low molecular weight heparin (LMWH) at therapeutic doses (enoxaparin 80 mg/24 mg).
The next day he was admitted to the resuscitation unit (REA) where intra-arterial fibrinolysis with urokinase was performed.
At 8h, a better distal perfusion was observed in the left hand, with partial recovery of mobility and sensitivity in it, and significant pain decrease.
Five days later, the patient was discharged with a new treatment: etravirine, lamivudine and raltegraviin-antiretroviral therapy 60mg/24h plus prophylaxis (AS sc 100).
