Interferon gamma
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Reactions 540 - 4 Mar 1995 S Interferon gamma Exacerbation of Kaposi’s sarcoma in a patient with AIDS: case report Progression of Kaposi’s sarcoma was noted in a 40-year-old man with AIDS after he was treated with interferon-γ and antimony for visceral leishmaniasis. The patient, who was receiving zidovudine and cotrimoxazole [trimethoprim/sulfamethoxazole], was diagnosed with visceral leishmaniasis after a trip to Mexico. Three Kaposi’s sarcoma lesions had been noted prior to this diagnosis. The man had no fever, despite widespread dissemination of the parasite, and CD4+ cells were not detected. Initially he was treated with pentavalent antimony, but when he developed thrombocytopenia within 4 days, a dose reduction was required. As no improvement was noted, he was given additional treatment with interferon-γ [Polyferon ® 50] 50 µg/day for 3 consecutive days. Ten hours later, he developed fever which abated after 5 days. Ten new Kaposi’s sarcoma lesions were noted soon after the first treatment cycle. The patient was treated 14 days later with pentavalent antimony and SC interferon-γ 50µg on day 1, increasing to 100µg on days 2 and 3. He again developed a fever, which subsided after 6 days. Ten days after this treatment, the patient’s existing Kaposi’s sarcoma lesions increased in size and another 10 new lesions were observed. On day 13 treatment was stopped when his platelet level fell to 39/nl. One week later, a third treatment cycle was started, identical to the second, and again tumour progression was noted within 1–2 weeks after the treatment began. Approximately 100 new lesions were evident, but once the treatment was stopped, no new lesions occurred over the next 2 months. The patient died of progressive pulmonary Kaposi’s sarcoma and bacterial pneumonia approximately 16 months after he was first treated for visceral leishmaniasis. Author comment: ‘A proliferative effect of interferon-γ is a likely explanation considering the temporal association of therapy and occurrence of the new lesions . . . [However] it cannot be ruled out that his KS [Kaposi’s sarcoma] progression was caused by a worsening of the patient’s immune status induced by visceral leishmaniasis or withdrawal of antiretrovirals as opposed to being caused by interferon-γ.’ Albrecht H, et al. Treatment of atypical leishmaniasis with interferon gamma resulting in progression of Kaposi’s sarcoma in an AIDS patient. Clinical Investigator 72: 1041-1047, Dec 1994 - Germany 800332532 1 Reactions 4 Mar 1995 No. 540 0114-9954/10/0540-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Interferon gamma
Reactions 540 - 4 Mar 1995
SInterferon gamma
Exacerbation of Kaposi’s sarcoma in a patient withAIDS: case report
Progression of Kaposi’s sarcoma was noted in a 40-year-oldman with AIDS after he was treated with interferon-γ andantimony for visceral leishmaniasis.
The patient, who was receiving zidovudine andcotrimoxazole [trimethoprim/sulfamethoxazole], wasdiagnosed with visceral leishmaniasis after a trip to Mexico.Three Kaposi’s sarcoma lesions had been noted prior to thisdiagnosis. The man had no fever, despite widespreaddissemination of the parasite, and CD4+ cells were notdetected. Initially he was treated with pentavalent antimony,but when he developed thrombocytopenia within 4 days, adose reduction was required. As no improvement was noted,he was given additional treatment with interferon-γ[Polyferon® 50] 50 µg/day for 3 consecutive days. Ten hourslater, he developed fever which abated after 5 days. Ten newKaposi’s sarcoma lesions were noted soon after the firsttreatment cycle.
The patient was treated 14 days later with pentavalentantimony and SC interferon-γ 50µg on day 1, increasing to100µg on days 2 and 3. He again developed a fever, whichsubsided after 6 days. Ten days after this treatment, thepatient’s existing Kaposi’s sarcoma lesions increased in sizeand another 10 new lesions were observed. On day 13treatment was stopped when his platelet level fell to 39/nl.
One week later, a third treatment cycle was started, identicalto the second, and again tumour progression was noted within1–2 weeks after the treatment began. Approximately 100 newlesions were evident, but once the treatment was stopped, nonew lesions occurred over the next 2 months. The patient diedof progressive pulmonary Kaposi’s sarcoma and bacterialpneumonia approximately 16 months after he was first treatedfor visceral leishmaniasis.
Author comment: ‘A proliferative effect of interferon-γ is alikely explanation considering the temporal association oftherapy and occurrence of the new lesions . . . [However] itcannot be ruled out that his KS [Kaposi’s sarcoma] progressionwas caused by a worsening of the patient’s immune statusinduced by visceral leishmaniasis or withdrawal ofantiretrovirals as opposed to being caused by interferon-γ.’Albrecht H, et al. Treatment of atypical leishmaniasis with interferon gammaresulting in progression of Kaposi’s sarcoma in an AIDS patient. ClinicalInvestigator 72: 1041-1047, Dec 1994 - Germany 800332532
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Reactions 4 Mar 1995 No. 5400114-9954/10/0540-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
