Sei sulla pagina 1di 7

Revista

CASO CLÍNICO México


Revista Alergia México "!

DĂŶƵĞůŶĂƐƚĂĐŝŽ^ĄŶĐŚĞnjͲKůŝǀĂƐ1
/PWLYZLUZPIPSPKHKHStYNPJHH Martha Patricia Valencia-Zavala1
'lŽria ertha VeŐa-ZŽďleĚŽ2,4
HU[PYYL[YV]PYHSLZ!L[YH]PYPUH :eƐƷƐ lďertŽ ^Ąnchenj-KlivaƐ2
Guillermo Velázquez-Sámano3
YHS[LNYH]PY`KHY\UH]PY Guadalupe Sepúlveda-Velázquez5
1
Médico adscrito al Servicio de Alergia e Inmuno-
logía Clínica.
9,:<4,5 2
Médico de apoyo al Servicio de Alergia e Inmuno-
;VKVZSVZMmYTHJVZHU[PYYL[YV]PYHSLZ[PLULULMLJ[VZHK]LYZVZX\LW\LKLU logía Clínica.
3
Jefe del Servicio de Alergia e Inmunología Clínica.
THUPMLZ[HYZL H JVY[V V SHYNV WSHaV ,S YPLZNV KL LMLJ[VZ ZLJ\UKHYPVZ
Hospital General de México, O.D.
LZWLJxÄJVZ]HYxHKL\UMmYTHJVHV[YVKL\UHJSHZLKLTLKPJHTLU[V 4
ŽĐƚŽƌĂĞŶ/ŶŵƵŶŽůŽŐşĂ͕ĂƚĞĚƌĄƟĐĂ͘
HV[YH`KL\UWHJPLU[LHV[YV<UHTLQVYJVTWYLUZP}UKLLZ[VZLMLJ[VZ 5
YƵşŵŝĐĂ&ĄƌŵĂĐŽͲŝſůŽŐĂ͕ĞƉĂƌƚĂŵĞŶƚŽĚĞ/ŶǀĞƐ-
LZKLPU[LYtZUVZ}SVWHYHSVZLZWLJPHSPZ[HZLU=0/ZPUV[HTIPtUWHYH ƟŐĂĐŝſŶůşŶŝĐĂ͕&ĂĐƵůƚĂĚĚĞYƵşŵŝĐĂ͘
V[YVZTtKPJVZX\LH[LUKLTVZSHZYLHJJPVULZHStYNPJHZLUSVZWHJPLU[LZ hŶŝǀĞƌƐŝĚĂĚEĂĐŝŽŶĂůƵƚſŶŽŵĂĚĞDĠdžŝĐŽ͘
=0/WVZP[P]VZ*HKHMmYTHJVHU[PYYL[YV]PYHSZLHZVJPHJVUZ\ZWYVWPVZ
LMLJ[VZHK]LYZVZLZWLJxÄJVZVW\LKLJH\ZHYWYVISLTHZZ}SVLUJPYJ\UZ-
[HUJPHZWHY[PJ\SHYLZ,ULZ[LHY[xJ\SVZLYL]PZHUHSN\UVZLMLJ[VZHStYNPJVZ
HK]LYZVZKLS[YH[HTPLU[VHU[PYYL[YV]PYHSKLNYHUHJ[P]PKHK;(9.(LU
LS [YH[HTPLU[V KLS=0/ KL \U WHJPLU[L 5\LZ[YV VIQL[P]V LZ VI[LULY
\UJVUVJPTPLU[VWYmJ[PJVKLLZ[VZLMLJ[VZHK]LYZVZWYVTV]PLUKVLS
YLJVUVJPTPLU[V[LTWYHUV`SHYL]LYZP}UKLSVZLMLJ[VZHK]LYZVZNYH]LZ
`YLK\JPYSHZPU[LYHJJPVULZMHYTHJVS}NPJHZHK]LYZHZ
7HSHIYHZ JSH]L! TLKPJHTLU[VZ HU[PYYL[YV]PYHSLZ LMLJ[VZ ZLJ\UKHYPVZ
YLHJJPVULZ HStYNPJHZ [YH[HTPLU[V HU[PYYL[YV]PYHS KL NYHU HJ[P]PKHK
;(9.(

(SSLYNPJO`WLYZLUZP[P]P[`[VHU[PYL[YV]PYHS
KY\NZ!L[YH]PYPULYHS[LNYH]PYHUK
KHY\UH]PY
():;9(*;
(SSHU[PYL[YV]PYHSKY\NZJHUOH]LIV[OZOVY[[LYTHUKSVUN[LYTHK]LYZL Recibido: 12 de diciembre 2014
L]LU[Z;OLYPZRVMZWLJPÄJZPKLLMMLJ[Z]HYPLZMYVTKY\N[VKY\NMYVTKY\N Aceptado: 15 de enero 2015
JSHZZ[VKY\NJSHZZHUKMYVTWH[PLU[[VWH[PLU[(IL[[LY\UKLYZ[HUKPUNVM
[OLHK]LYZLLMMLJ[ZVMHU[PYL[YV]PYHSHNLU[ZPZVMPU[LYLZ[UV[VUS`MVY/0=
ZWLJPHSPZ[ZI\[HSZVMVYV[OLYWO`ZPJPHUZ^OVJHYLHSSLYN`YLHJ[PVUZPU Correspondencia: Dra. Martha Patricia Valencia
Zavala
/0=WVZP[P]LWH[PLU[Z,HJOHU[PYL[YV]PYHSTLKPJH[PVUPZHZZVJPH[LK^P[O
Zacatecas 44, segundo piso, consultorio 203
P[ZV^UZWLJPÄJHK]LYZLLMMLJ[ZVYTH`JH\ZLWYVISLTZVUS`PUWHY[PJ\SHY
06700 México, DF
JPYJ\TZ[HUJLZ0U[OPZHY[PJSLZVTLHK]LYZLHSSLYNPJLMMLJ[ZVM/((9;
valenciazavala@hotmail.com
[OLYHW`PU[OL[YLH[TLU[VM/0=MYVTHWH[PLU[HYLYL]PL^LK6\YHPT
PZ[VNHPUH^VYRPUNRUV^SLKNLVM[OLZLHK]LYZLLMMLJ[ZWYVTV[PUN[OL
ƐƚĞĂƌơĐƵůŽĚĞďĞĐŝƚĂƌƐĞĐŽŵŽ
LHYS`YLJVNUP[PVUHUKYL]LYZHSVMWV[LU[PHSS`ZLYPV\ZHK]LYZLLMMLJ[ZHUK
Sánchez-Klivas M, Valencia-Zavala MP, Vega-Zo-
YLK\JPUN[OLWV[LU[PHSMVYHK]LYZLKY\NPU[LYHJ[PVUZ
ďledo G, Sánchez-Klivas : LJ col. ,ipersensiďilidad
2L`^VYKZ!HU[PYL[YV]PYHSKY\NZZPKLLMMLJ[ZHSSLYN`YLHJ[PVUZ/((9; alérgica a anƟrretrovirales͗ etravirina, raltegravir LJ
[OLYHW` darunavir. Revista Alergia México 2015;62:142-148.

 www.nietoeditores.com.mx
Revista

México
Sánchez-Olivas MA y col. Hipersensibilidad alérgica a antirretrovirales

ANTECEDENTES *\HKYV . 9LHJJPVULZ HK]LYZHZ H TLKPJHTLU[VZ TmZ


MYLJ\LU[LZ WVY SH HKTPUPZ[YHJP}U KL JVTIPUHJPVULZ KL
HU[PYYL[YV]PYHSLZ
+LHJ\LYKVJVUSHZYLJVTLUKHJPVULZKLS*VUZL-
QV(ZLZVY*SxUPJV*(*KLS7SHU5HJPVUHSZVIYL ;V_PJPKHKTP[VJVUKYPHSTHUPMLZ[HKHJVTV!HJPKVZPZSmJ-
[PJHOLWH[V[V_PJPKHKWHUJYLH[P[PZUL\YVWH[xHWLYPMtYPJH
LS:0+(1LS[YH[HTPLU[VKLSHPUMLJJP}UWVYLS
(UVYTHSPKHKLZTL[HI}SPJHZLU[YLSHZX\LKLZ[HJHU!re-
]PY\ZKLSHPUT\UVKLÄJPLUJPHO\THUH=0/OH KPZ[YPI\JP}UNYHZHJHTIPVZLUSHJVTWVZPJP}UJVYWVYHS
L]VS\JPVUHKVOHJPHSHWYLZJYPWJP}UKLHZVJPHJPV- OPWLYSPWPKLTPHOPWLYNS\JLTPHYLZPZ[LUJPHHSHPUZ\SPUH
ULZKL[YLZVTmZMmYTHJVZX\LOHUKLTVZ[YHKV ,]LU[VZOLTH[VS}NPJVZHK]LYZVZLUJVU[YHKVZLU!anemia,
neutropenia, trombocitopenia
TLQVYLZYLZ\S[HKVZJSxUPJVZ]PYVS}NPJVZLPUT\- 9LHJJPVULZHStYNPJHZSHZTmZMYLJ\LU[LZZVU!L_HU[LTH
UVS}NPJVZJVUKPZTPU\JP}ULUSHTVYIPSPKHK` J\[mULVYLHJJPVULZKLOPWLYZLUZPIPSPKHK
TVY[HSPKHKKLSVZWHJPLU[LZ=0/`TLQVYxHKL
Z\JHSPKHKKL]PKH1,S[YH[HTPLU[VHU[PYYL[YV]PYHS
KLNYHUHJ[P]PKHK;(9.(LULZWH|VSV/((9; HU[PYYL[YV]PYHS KL NYHU HJ[P]PKHK ;(9.( X\L
LUPUNStZZLIHZHLUJVTIPUHJPVULZKL]HYPVZ PUJS\xH 0U[LSLUJL® L[YH]PYPUH  TNK 0ZLU-
MmYTHJVZX\LHJ[‚HUZVIYLSHZLUaPTHZKLS=0/ tress®YHS[LNYH]PYTNK7YLaPZ[H®KHY\UH]PY
VZVIYLV[YVZWHZVZJVTVSHM\ZP}U`HSN\UHZ [HISL[HZKLTNK"KLZW\tZKL[YLZZLTHUHZ
L[HWHZKLSHTHK\YHJP}UKLS]PY\Z KL[VTHYLZ[VZTLKPJHTLU[VZLSKLVJ[\IYL
KL  PUNYLZ} HS :LY]PJPV KL <YNLUJPHZ JVU
+LZKLLSPUPJPVKLS[YH[HTPLU[VHU[PYYL[YV]PYHSKL KPHNU}Z[PJVKLLYP[YVKLYTPH`L_HU[LTHTmJ\SV
NYHUHJ[P]PKHK;(9.(LU tZ[LJHTIP} WHW\SHY NLULYHSPaHKV HJVTWH|HKV KL WY\YP[V
LSWYVU}Z[PJVKLTHULYHYHKPJHSJVUH\TLU[V PU[LUZV KL JPUJV KxHZ KL L]VS\JP}U" WVZ[LYPVY-
KL SH Z\WLY]P]LUJPH WVYX\L JVUZPN\L SH YLZ- TLU[LSHWPLSZL[VYU}]PVSmJLHJVU]LZxJ\SHZKL
[H\YHJP}U PUT\UVS}NPJH L]P[H SH TH`VY WHY[L JVU[LUPKVZLYVZVSLZPVULZ\SJLYH[P]HZLUSHIVJH
KLSHZPUMLJJPVULZVWVY[\UPZ[HZ`MVYTHJP}UKL `SH]HNPUHYVJOHZNLULYHSPaHKHZ[LTWLYH[\YH
[\TVYLZ`NLULYHSTLU[LZLOHJLUPUULJLZHYPHZ H_PSHY KL  ¢* TPHSNPHZ ` HZ[LUPH ZPU KH[VZ
SHZWH\[HZKLWYVÄSH_PZ3HHKTPUPZ[YHJP}UWYV- L]PKLU[LZKL\UMVJVPUMLJJPVZVHUNPVLKLTHKL
NYLZP]HKLS;(9.(OHVYPNPUHKV\UJHTIPVLU SVZWmYWHKVZKLHTIVZVQVZ`KLSHZTHUVZZLU-
LS[YH[HTPLU[VKLSHPUMLJJP}UWVYLS=0/NLUL- ZHJP}UKLJHUZHUJPV`Z\L|VLUZ\ZL_mTLULZ
YHUKVYLK\JJPVULZPTWVY[HU[LZLUSHTVY[HSPKHK KLSHIVYH[VYPV[\]VLVZPUVÄSPH`[YHUZHTPUHZLTPH
`TVYIPSPKHKHZVJPHKHZ,Z[VOHJVUKPJPVUHKV SL]LHKLTmZKLKLZLX\PSPIYPVOPKYVLSLJ[YVSx[PJV
X\LSHPUMLJJP}UWVYLS=0/HOVYHZLJVUZPKLYL WVYOPWVUH[YLTPHLOPWVJHSLTPH7VYSVZKH[VZKL
\UHLUMLYTLKHKJY}UPJH`UV\UHLUMLYTLKHK Z\OPZ[VYPHJSxUPJH`SVZYLZ\S[HKVZKLSVZLZ[\KPVZ
terminal.23HWYLZJYPWJP}UKLJVTIPUHJPVULZKL KL SHIVYH[VYPV ZL KLJPKP} Z\ZWLUKLYSL LS [YH[H-
HNLU[LZ HU[PYYL[YV]PYHSLZ JVTV SVZ PUOPIPKVYLZ TPLU[VHU[PYYL[YV]PYHS`ZLSLHKTPUPZ[Y}PUM\ZP}U
KLSH[YHUZJYPW[HZHPU]LYZHHUmSVNVZKLSVZU\- KL WLU[V_PÄSPUH H KVZPZ LUKV]LUVZH KL PUPJPV
JSL}ZPKVZ ` KL SVZ U\JSL}[PKVZ OH JVUK\JPKV KL  TNKxH X\L S\LNV ZL H\TLU[}  TN
HS YLJVUVJPTPLU[V KL YLHJJPVULZ HK]LYZHZ H WVYKxHOHZ[HSSLNHYHTNKxHLZ[LYVPKLVYHS
TLKPJHTLU[VZ HU[PYYL[YV]PYHSLZ JVTV SHZ X\L WYLKUPZVSVUHHTNRNKxHJ\`HKVZPZZL
ZLTLUJPVUHULULS*\HKYV YLK\QVHSHJ\HY[HZLTHUHWVYVI[LULYTLQVYxH`
JVTIPUHJP}UKLHU[POPZ[HTxUPJVZ!KPOPKYVJSVY\YV
CASO CLÍNICO KLJL[PYPaPUHJVTWYPTPKVZJVUTNKxHTmZ
YLWVZPJP}U OPKYVLSLJ[YVSx[PJH" SH WHJPLU[L [\]V
7HJPLU[LMLTLUPUHKLH|VZKLLKHK=0/WV- HSP]PVL]PKLU[LKLSHZSLZPVULZKtYTPJHZYLTPZP}U
ZP[P]HKLZKLOHJxHH|VZYLJPIxH[YH[HTPLU[V KLSHÄLIYL`UVYTHSPaHJP}UKLSHJ\HU[PÄJHJP}U


Revista Alergia México Volumen 62, Núm. 2, abril-junio 2015

KLLVZPU}ÄSVZOPKYVLSLJ[YVSx[PJH`KLSHZLUaPTHZ IHQH KLUZPKHK KL  TNK3  H  TN


OLWm[PJHZWVYSVX\LM\LKHKHKLHS[H K3 WY\LIHZ KL M\UJP}U OLWm[PJH JVU NHTTH
NS\[HTPS [YHUZMLYHZH KL  ›3  H  ›3 LS
,SKLVJ[\IYLSHWHJPLU[LHJ\KP}HSHJVUZ\S[H LZ[\KPVJVWYVWHYHZP[VZJ}WPJVJVU[YLZT\LZ[YHZ
L_[LYUH KLS :LY]PJPV KL(SLYNPH L 0UT\UVSVNxH L]PKLUJP} X\PZ[LZ KL Blastocystis hominis `
*SxUPJH WHYH KL[LYTPUHY ZP LS J\HKYV KLYTH- HI\UKHU[LZNYHZHZ0N.KL TNK3H
[VS}NPJV ` KL LZ[\KPVZ KL SHIVYH[VYPV OHIxH TNK30N,KLH<0T3SHZ
ZPKV JH\ZHKV WVY SVZ HU[PYYL[YV]PYHSLZ ,U LZL KLTmZPUT\UVNSVI\SPUHZ`JVTWSLTLU[VM\LYVU
TVTLU[V OHIxH YLPUPJPHKV KLZKL OHJxH  UVYTHSLZ,SYLZ\S[HKVKLSHJ\HU[PÄJHJP}UKLSH
KxHZ L[YH]PYPUH YHS[LNYH]PY ` KHY\UH]PY" LU SH JHYNH]PYHSM\LKLJVWPHZT3SVNJVWPHZ
OPZ[VYPHJSxUPJHKLZ[HJ}X\LSHWHJPLU[LYLMLYxH T3*\HKYV`LS*+M\LKL JtS\SHZ
WY\YP[VPU[LUZVNLULYHSPaHKVSHÄLIYL`SHZ‚S- ›3*\HKYV3HKVZPÄJHJP}UKL*+*+
JLYHZVYHSLZ`]HNPUHSLZSLK\YHYVUJ\H[YVKxHZ *+`LSJVJPLU[L*+*+ZLT\LZ[YHULULS
KLZW\tZKLOHILYZ\ZWLUKPKVSVZTLKPJHTLU- *\HKYV3HZWY\LIHZKLLZJHYPÄJHJP}UM\LYVU
[VZ HU[PYYL[YV]PYHSLZ +LZW\tZ KL  KxHZ KLS WVZP[P]HZJVU[VKVZSVZHU[PYYL[YV]PYHSLZ
YLPUPJPV KL Z\ [YH[HTPLU[V THUPMLZ[} WY\YP[V
PU[LUZV" LS PUMLJ[}SVNV [YH[HU[L SL [YHUZÄYP} HS 3H ]PYLTPH WSHZTm[PJH LZ LS PUKPJHKVY TmZ
ZLY]PJPVKL(SLYNVSVNxHL0UT\UVSVNxH*SxUPJH WV[LU[LKLSHWYVNYLZP}UKLSZxUKYVTLKLPU-
JVULSKPHNU}Z[PJVWYVIHISLKLYLHJJP}UHStY- T\UVKLÄJPLUJPH ,S KPHNU}Z[PJV KL YLHJJP}U
NPJH HS [YH[HTPLU[V JVU HU[PYYL[YV]PYHSLZ( SH HStYNPJH H HU[PYYL[YV]PYHSLZ ZL YLHSPa} JVU
L_WSVYHJP}U MxZPJH UV ZL VIZLY]HYVU SLZPVULZ IHZL LU SH OPZ[VYPH JSxUPJH ` SVZ LZ[\KPVZ KL
KtYTPJHZ LS YLZ[V KL SH L_WSVYHJP}U MxZPJH ` SHIVYH[VYPV WYPUJPWHSTLU[L! SH LSL]HJP}U KL
SVZZPNUVZ]P[HSLZM\LYVUUVYTHSLZ"WVYZLN\U- SH 0N, ` 0N. SH LVZPUVÄSPH SH WVZP[P]PKHK KL
KH]LaZLSLZ\ZWLUKP}LS[YH[HTPLU[V`JPUJV [VKHZSHZWY\LIHZJ\[mULHZWVYLZJHYPÄJHJP}UH
ZLTHUHZWVZ[LYPVYLZZLYLWP[PLYVUSVZLZ[\KPVZ HU[PYYL[YV]PYHSLZ`SHHS[LYHJP}UKLSHZWY\LIHZ
KLSHIVYH[VYPV`KLHJ\LYKVJVUZ\ZYLZ\S[HKVZ KLM\UJP}UOLWm[PJH
TmZSVZKH[VZVI[LUPKVZLUSHOPZ[VYPHJSxUPJH
` SH YL]PZP}U YLJPLU[L KL SH WHJPLU[L X\L ZL
LUJVU[YHIHJSxUPJHTLU[LLZ[HISLZLWYVNYHT} *\HKYV.*HYNH]PYHSKLSHWHJPLU[L
SHYLHSPaHJP}UKLWY\LIHZJ\[mULHZJVUTt[VKV
,_mTLULZKLIPVSVNxHTVSLJ\SHY
KLLZJHYPÄJHJP}UJVUKPS\JPVULZVI[LUPKHZKL *HYNH]PYHSJVWPHZT3!SVNJVWPHZT3
L[YH]PYPUHYHS[LNYH]PY`KHY\UH]PY

Resultados de los estudios de laboratorio *\HKYV.,_mTLULZKLJP[VTL[YxHKLÅ\QV4\S[P[LZ[*+


*+*+*+)+-(*:*HSPI\Y®
)PVTL[YxH OLTm[PJH JVU SL\JVWLUPH KL  
9LZ\S[HKVZKLZ\IWVISHJP}USPUMVJP[HYPH Referencia
 H   UL\[YVWLUPH KL    H  
SPUMVJP[VZPZ H TVUVJP[VZPZ  *+JtS\SHZ›3! 
H LVZPU}ÄSVZKL H ™_ 3 *+JtS\SHZ›3! 
*+ 
L_HTLUNLULYHSKLVYPUHJVU\YLHKLTNK3
*+JtS\SHZ›3!  
X\xTPJH ZHUN\xULH JVU JVSLZ[LYVS KL  TN
*+ 
K3HTNK3[YPNSPJtYPKVZKLTNK3 *+JtS\SHZ›3!  
HTNK3SPWVWYV[LxUHZKLHS[HKLUZPKHK *+  
KLTNK3HTNK3SPWVWYV[LxUHZKL *VJPLU[L*+*+! 1-1.5


Revista

México
Sánchez-Olivas MA y col. Hipersensibilidad alérgica a antirretrovirales

Síndrome de reconstitución inmunitaria J\HSP[H[P]HTLU[L`KLYLWLU[L\UZPUU‚TLYVKL


TPJYVVYNHUPZTVZ]PY\SLU[VZX\LW\KPLYVUOHILY
3VZ L]LU[VZ WH[VS}NPJVZ LU \U WHJPLU[L=0/ LZ[HKVLULSVYNHUPZTVZPUWYVK\JPYLUMLYTLKHK
WVZP[P]V ZVU T‚S[PWSLZ JVUZPKLYHUKV LS KH|V JSxUPJH ZL THUPÄLZ[HU \U LMLJ[V PUÅHTH[VYPV
PUK\JPKV WVY SH WYVWPH PUMLJJP}U ]PYHS SH HK- ` TLJHUPZTVZ KL YLHJJP}U PUT\UVS}NPJH TL-
TPUPZ[YHJP}U KL HU[PYYL[YV]PYHSLZ ` Z\Z LMLJ[VZ QVYHKVZ L PU[LUZPÄJHKVZ H[HJHU HS VYNHUPZTV
HK]LYZVZ [}_PJVZ L PUT\UVS}NPJVZ ` HStYNPJVZ PUMLJ[HU[L WYVK\JPLUKV KH|V H SVZ WH[}NLUVZ
JVTV LU SVZ WYPTLYVZ [YLZ TLZLZ KL PUPJPHY LS VWVY[\UPZ[HZ`HSVZ[LQPKVZJPYJ\UKHU[LZSVX\L
;(9.(LUX\LWVKLTVZLUJVU[YHYPUMLJJPVULZ WYVK\JLZxU[VTHZNYH]LZ`WYVSVUNHKVZMVYTHU-
VWVY[\UPZ[HZ ,_PZ[L \UH JSHYH YLSHJP}U PU]LYZH KVHZxLSZxUKYVTLPUÅHTH[VYPVKLYLJVUZ[P[\JP}U
LU[YLLSU‚TLYVKLJtS\SHZ*+LUZHUNYLWLYP- PUT\UVS}NPJH:090LUWHJPLU[LZJVU=0/
MtYPJH`LSYPLZNVKLWHKLJLYLZ[HZPUMLJJP}ULZ
(ZxLUWHJPLU[LZHZPU[VTm[PJVZLSJVU[LVJLS\SHY 3VZ WYPTLYVZ JHZVZ KL PUMLJJP}U WVY Myco-
*+V[VYNH\UJYP[LYPVTH`VYWHYHLSPUPJPVKL bacterium avium HZVJPHKH JVU ZxUKYVTL KL
WYVÄSH_PZWYPTHYPHJVU[YHLZ[L[PWVKLLUMLYTLKH- reconstitución inmunológica se reportaron luego
KLZJVTVUL\TVUxHWVYPneumocystis jirovecci, KLTVUV[LYHWPHJVUaPKV]\KPUH"ZLVIZLY]}X\L
JVUVJPKHOHZ[HOHJLWVJVJVTVP. carinii+L SVZHU[xNLUVZKLSHLZWLJPLMycobacterium con
THULYHPU]LYZHLSH\TLU[VLULSJVU[LVJLS\SHY MYLJ\LUJPH LZ[mU PTWSPJHKVZ ,_PZ[L \UH NYHU
*+S\LNVKLSHZ\WYLZP}UKLSHYLWSPJHJP}UKLS SPZ[H KL V[YVZ WH[}NLUVZ VWVY[\UPZ[HZ JVTV
=0/WVYLS[YH[HTPLU[VHU[PYYL[YV]PYHSZLJVYYLSH- Cryptococcus neoformans, JP[VTLNHSV]PY\Z]P-
JPVUHJVUYLZW\LZ[HZTLQVYHKHZKLSHWVISHJP}U Y\ZKLOLWH[P[PZ)`*YLJPLU[LTLU[LYLWVY[HKVZ
JLS\SHY;JVU[YHHU[xNLUVZ`TP[}NLUVZSVX\L LSNY\WVKLSVZWVSPVTH]PY\Z!1*HZVJPHKVJVU
NLULYHSHHKLJ\HKHWYV[LJJP}UJVU[YHPUMLJJPV- SL\JVLUJLMHSVWH[xHKLZTPLSPUPaHU[L`)2HZV-
ULZVWVY[\UPZ[HZLZWLJxÄJHZ+LLZ[HMVYTHSH JPHKVJVUJPZ[P[PZOLTVYYmNPJH,U[YLSVZMHJ[VYLZ
JHYNH ]PYHS KL=0/ ` LS JVU[LV JLS\SHY; *+ KLYPLZNVKLWHKLJLYZxUKYVTLKLYLJVUZ[P[\JP}U
YLWYLZLU[HU SVZ THYJHKVYLZ Z\Z[P[\[VZ WHYH SH PUT\UVS}NPJHLZ[mU!SVZHU[xNLUVZKLWH[}NLUVZ
L]HS\HJP}U KL YPLZNV KL :0+( HZx JVTV KL SH VWVY[\UPZ[HZYLSHJPVUHKVZJVUPUMLJJP}UHJ[P]H
ULJLZPKHK KL;(9.( WYVÄSH_PZ V HTIHZ5 El LPUMLJJP}UZ\IJSxUPJHSHL_PZ[LUJPHKLNLULZ
ZxUKYVTL KL YLJVUZ[P[\JP}U PUT\UVS}NPJH LZ YLSHJPVUHKVZJVUZLUZPIPSPKHKWHYHSHHWHYPJP}U
LS JVUQ\U[V KL YLHJJPVULZ WYVK\JPKHZ WVY SH KL LUMLYTLKHKLZ BWVY LQLTWSV WVY OLYWLZ
TLQVYxHPUT\UVS}NPJHPUK\JPKHWVYLS;(9.( ]PY\Z/3(()+9VWVYTPJVIHJ[LYPHZ
X\LKLWLUKLLUNYHUTLKPKHKLSHJVUKPJP}UKL ;5-( 03 .D ` LS JVU[LV JLS\SHY
SVZWHJPLU[LZ;HTIPtUPUÅ\`LLSUP]LSKLJVU- *+#JtS\SHZT3YLSHJPVUHKVJVU\UHJHYNH
[LVJLS\SHYKL*+H KLSVZWHJPLU[LZ WH[VNtUPJH LSL]HKH ` KLZYLN\SHJP}U PUT\UP[H-
PUPJPHSHHKTPUPZ[YHJP}UKLHU[PYYL[YV]PYHSLZJVU YPH  ,S PUPJPV KLS ZxUKYVTL KL YLJVUZ[P[\JP}U
UP]LSLZT\`IHQVZSHHKTPUPZ[YHJP}U[HYKxHKL PUT\UVS}NPJHZLKPZ[PUN\LWVYLSLTWLVYHTPLU[V
SVZ HU[PYYL[YV]PYHSLZ J\HUKV LS WHJPLU[L ZL OH WHYHK}QPJVKLSVZWHYmTL[YVZJSxUPJVZ`KLSHIV-
KL[LYPVYHKV WVY SHYNV [PLTWV KLIPKV HS=0/ YH[VYPVLUSVZWHJPLU[LZHMLJ[HKVZ"NLULYHSTLU[L
SH LKHK ` LS LZ[HKV U\[YPJPVUHS MHJ[VYLZ X\L LSJVU[LVJLS\SHY*+LZTLUVYKLJtS\SHZ
MHJPSP[HU SH YLHJ[P]PKHK KL PUMLJJPVULZ X\L `H T3J\HUKVZLPUPJP}LS;(9.(`WVZ[LYPVYTLU[L
[LUxHLSO\tZWLKKLTHULYHZ\IJSxUPJH`X\LZL H\TLU[HTmZKLKVZHJ\H[YV]LJLZK\YHU[LSVZ
]LUL_HJLYIHKHZWVYSHYLZ[H\YHJP}UKLSZPZ[LTH  TLZLZ KLZW\tZ KL PUPJPHKV LS [YH[HTPLU[V
inmunológico.6 *\HUKV LS ZPZ[LTH PUT\UVS}- JVUKPZTPU\JP}UZPNUPÄJH[P]HKLSHJHYNH]PYHS
NPJVLZYLJVUZ[P[\PKVWVYLS;(9.(SHZJtS\SHZ KL=0/%SVNZLUJVWPHZT3:PULTIHYNVSH
*+YLHSaHUZ\ZJVUJLU[YHJPVULZJ\HU[P[H[P]H` L_WLYPLUJPHPUPJPHSYLWVY[HKHS\LNVKLSPUPJPVKL


Revista Alergia México Volumen 62, Núm. 2, abril-junio 2015

TVUV[LYHWPHJVUaPKV]\KPUH(A;Z\NPLYLX\L HWSHaHU SH HKTPUPZ[YHJP}U KLS;(9.( K\YHU[L


WVKYxHUZLYZ\ÄJPLU[LZWLX\L|HZPU[LYY\WJPVULZ [YLZZLTHUHZWHYHL]P[HYLSLSL]HKVU‚TLYVKL
KL SH YLWSPJHJP}U KLS=0/ WHYH X\L VJ\YYH LS KVZPZ[V_PJPKHKHJ\T\SHKH`WVZPISLHWHYPJP}U
ZxUKYVTL KL YLJVUZ[P[\JP}U PUT\UVS}NPJH LU KL ZxUKYVTL KL YLJVUZ[P[\JP}U PUT\UVS}NPJH
YLZW\LZ[HHSHL_PZ[LUJPHKLHU[xNLUVZWHY[PJ\- :PtZ[LVJ\YYLLSKPHNU}Z[PJVKPMLYLUJPHSPUJS\`L
SHYTLU[L SVZ KL SVZ WH[}NLUVZ VWVY[\UPZ[HZ ,S MHSSH KLS;(9.( THUPMLZ[HJP}U KL \UH U\L]H
PU[LY]HSVLU[YLLSPUPJPVKLS;(9.(`LSPUPJPV PUMLJJP}UVWVY[\UPZ[HLUTHZJHYHTPLU[VKL\UH
KLSZxUKYVTLKLYLJVUZ[P[\JP}UPUT\UVS}NPJHLZ PUMLJJP}ULUJ\YZVWYL]PHTLU[LUVKPHNUVZ[PJHKH
T\`]HYPHISL!LU[YLTLUVZKL\UHZLTHUHOHZ[H VTHUPMLZ[HJP}UKL\UHPUMLJJP}UKPHNUVZ[PJHKH
]HYPVZTLZLZJVUHWHYPJP}UKLSHTH`VYWHY[L LU\US\NHYWYL]PHTLU[LUVYLJVUVJPKV11(\U-
KL SVZ L]LU[VZ LU SHZ WYPTLYHZ VJOV ZLTHUHZ X\LKLILJVUZPKLYHYZLSHZ\ZWLUZP}UKLS;(9.(
S\LNV KLS PUPJPHY LS;(9.( WHY[PJ\SHYTLU[L SH TH`VYxH KL JSxUPJVZ WYLÄLYL JVU[PU\HY ZP LS
LU WHJPLU[LZ JVU JVU[LVZ IHQVZ KL *+10 3H JVU[LV *+ LZ TLUVY KL  JtS\SHZT3 V ZP
reconstitución inmunológica ocurre temprana- LSZxUKYVTLKLYLJVUZ[P[\JP}UPUT\UVS}NPJHZL
TLU[L LU YLZW\LZ[H H HU[xNLUVZ L_W\LZ[VZ KL THUPÄLZ[HTLZLZKLZW\tZKLOHILYPUPJPHKVLS
THULYH\IPJ\HVHI\UKHU[L`ZLJVYYLSHJPVUH ;(9.(
JVUH\TLU[VKLSHZJtS\SHZ*+KLTLTVYPH
3HPUT\UVWH[VSVNxHMYLU[LHKPMLYLU[LZWH[}NL- 5V L_PZ[LU N\xHZ JSHYHZ HJLYJH KL J\mUKV LZ
UVZ[PLULKP]LYZVZTLJHUPZTVZ"LSZxUKYVTLKL LS TLQVY TVTLU[V WHYH Z\ZWLUKLY LS;(9.(
reconstitución inmunológica micobacteriana o *VU IHZL LU YLWVY[LZ HULJK}[PJVZ LS;(9.(
M‚UNPJHWHYLJLZLYLSYLZ\S[HKVKL\UHYLZW\LZ[H ZL Z\ZWLUKL ZP SH YLZW\LZ[H PUMSHTH[VYPH LZ
KLOPWLYZLUZPIPSPKHK[HYKxHTPLU[YHZX\LLSX\L HTLUHaHU[L WHYH SH ]PKH ZP SH YLZW\LZ[H H SH
ZLHZVJPHJVU]PY\ZJVTVSVZKLOLYWLZYLZ\S[H HKTPUPZ[YHJP}UKLLZ[LYVPKLZLZLZJHZHVZPSVZ
KL \UH YLZW\LZ[H TLKPHKH WVY JtS\SHZ; *+ WH[}NLUVZPTWSPJHKVZUVZVUJVU[YVSHISLZJVU
3H HZVJPHJP}U KL ZxUKYVTL KL YLJVUZ[P[\JP}U [YH[HTPLU[V HU[PTPJYVIPHUV LZWLJxÄJV JVTV
PUT\UVS}NPJH WVY TPJVIHJ[LYPHZ ` ]PY\Z KLS VJ\YYLLUJHZVKLZxUKYVTLKLYLJVUZ[P[\JP}U
OLYWLZJVULSWVSPTVYÄZTVKLNLULZX\LJVKP- PUT\UVS}NPJHLUYLZW\LZ[HHWHY]V]PY\Z) V
ÄJHUKPMLYLU[LZJP[VJPUHZWYV]LLL]PKLUJPHKL WVSPVTH]PY\Z1*12VZPSH[V_PJPKHKKLS;(9.(
SVZKPMLYLU[LZ[PWVZKLYLZW\LZ[HPUT\UP[HYPHLS M\LLSWYPUJPWHSKPHNU}Z[PJVKPMLYLUJPHSJVTVLU
LMLJ[VHSHYNVWSHaVKLLZ[VZTLJHUPZTVZPUT\- LSJHZVKLOLWH[P[PZ"LUH KLSVZWHJPLU[LZ
nopatológicos aún no es claro. ZLVIZLY]HH\TLU[VKLSHZJVUJLU[YHJPVULZKL
[YHUZHTPUHZHZ S\LNV KL OHILY PUPJPHKV LS [YH-
3HZJVUZLJ\LUJPHZPUT\UVS}NPJHZ`TL[HI}SPJHZ [HTPLU[VJVUHU[PYYL[YV]PYHSLUHZVJPHJP}UJVU
KLSHWYVK\JJP}ULSL]HKHKL03JVU[YPI\`LUH JVPUMLJJP}UJVUOLWH[P[PZ)V*
SH WLYZPZ[LU[L HJ[P]HJP}U PUT\UVS}NPJH LU WH-
JPLU[LZJVUYLWSPJHJP}UKL=0/JVU[YVSHKHWVY <UVKLSVZMHJ[VYLZKLYPLZNVLZSHL_PZ[LUJPHKL
;(9.( 3H YLJVUZ[P[\JP}U PUT\UP[HYPH W\LKL OLWH[P[PZ ]PYHS JY}UPJH PUJS\PKHZ SHZ JH\ZHKHZ
KHYZLLUKVZZP[\HJPVULZKPMLYLU[LZJVUZPKLYHU- WVYLS]PY\ZKLOLWH[P[PZ)`*`SHPUJPKLUJPH
KVZPLS;(9.(ZLPUPJP}LU\UWHJPLU[L[YH[HKV KLPUZ\ÄJPLUJPHOLWm[PJHLU X\LZLHZVJPH
WVY \UH PUMLJJP}U VWVY[\UPZ[H `H PUZ[HSHKH V JVUJVU[LVZIHQVZKL*+WYVTLKPV! JtS\-
LU\UWHJPLU[LJSxUPJHTLU[LLZ[HISLJVUVZPU SHZT3SVX\LZ\NPLYL\UWHWLSPTWVY[HU[LKLS
PUKPJHJP}UKLWYVÄSH_PZWYPTHYPH7VYLQLTWSV ZxUKYVTLKLYLJVUZ[P[\JP}UPUT\UVS}NPJH123H
LUWHJPLU[LZJVUPUMLJJP}UHJ[P]H`[YH[HTPLU- OLWH[V[V_PJPKHK ZL HZVJPH JVU LZX\LTHZ KL
to antimicrobiano contra P. jirovecii 7*7 V ;(9.(X\LLU[YLZ\ZJVTWVULU[LZLZ[mU!UL]PYH-
Mycobacterium tuberculosis HSN\UVZ JSxUPJVZ WPUHLMH]PYLUaKPKHUVZPUHaHSJP[HIPUHYP[VUH]PY


Revista

México
Sánchez-Olivas MA y col. Hipersensibilidad alérgica a antirretrovirales

VZHX\PUH]PY:PULTIHYNVZ\ZWLUKLYLS;(9.( [YH[HTPLU[VHU[PYYL[YV]PYHS`SHYHWPKLaJVUX\L
W\LKL HZVJPHYZL JVU YLIV[L KL SH YLWSPJHJP}U ZLWYVK\JLW\LKLJH\ZHYX\LLSZPZ[LTHPUT\-
KLS]PY\ZKLOLWH[P[PZ)LUWHJPLU[LZJVUJVPU- UP[HYPVZL]\LS]HOPWLYHJ[P]VJVU[YHPUMLJJPVULZ
MLJJP}UWVYLZ[L]PY\Z`LS=0/X\PLULZYLJPILU ¸Z\IJSxUPJHZ¹ X\L ZVIYL]P]LU LU LS J\LYWV SV
LZX\LTHZIHZHKVZLUSHTP]\KPUHV[LUVMV]PY,U X\L YLZ\S[H LU ZxU[VTHZ NYH]LZ ` WYVSVUNHKVZ
LZ[VZ JHZVZ WVKYxH JVUZPKLYHYZL JVU[PU\HY JVU KLSHLUMLYTLKHKSVX\LKHS\NHYHSZxUKYVTL
TVUV[LYHWPHJVU[YHLS]PY\ZKLOLWH[P[PZ)JVU PUÅHTH[VYPVKLYLJVUZ[P[\JP}UPUT\UVS}NPJHLU
\UVKLLZ[VZKVZHNLU[LZ,USHWYmJ[PJHJSxUPJH WHJPLU[LZJVU=0/
SHJHYNH]PYHSZL\[PSPaHWHYHKL[LYTPUHYLSZxU-
KYVTLJVTWH[PISLJVU\UHPUMLJJP}UHN\KHWVY CONCLUSIONES
=0/SH]HSVYHJP}UPUPJPHSKL\UHPUMLJJP}UWVY
=0/SHKLJPZP}UKLPUPJPHY[YH[HTPLU[V`JVTV ,U[YLSVZLMLJ[VZUVJP]VZJH\ZHKVZLUWHJPLU[LZ
THYJHKVYKLYLZW\LZ[H[LYHWt\[PJH3HJHYNH]PYHS JVU=0/WVYSHHKTPUPZ[YHJP}UKLHU[PYYL[YV]PYH-
LZLSTLQVYTHYJHKVYWHYHWYLKLJPYSHWYVNYLZP}U SLZLZ[mUSHZ]HYPHJPVULZJSxUPJHZWH[VS}NPJHZ`
H:0+(`SHZ\WLY]P]LUJPH3HZJPMYHZKL*+ HKHW[H[P]HZX\LZVIYL]PLULUWVYSHKPZTPU\JP}U
[PLULUTLUVY]HSVYWYVU}Z[PJVX\PamWVYX\LSVZ KLJHYNH]PYHSLSLTWLVYHTPLU[VWHYHK}QPJVKL
JHTIPVZZLWYVK\JLUJVUYL[YHZVYLZWLJ[VKLSVZ SVZWHYmTL[YVZJSxUPJVZ`KLSHIVYH[VYPVLULZ[VZ
JHTIPVZLUSH]PYLTPH3HYLK\JJP}UKLSHJHYNH WHJPLU[LZHSPUPJPHYSHTHUPMLZ[HJP}UKLSZxUKYV-
]PYHSWVYKLIHQVKLJVWPHZT3ZLHZVJPHJVU TLKLYLJVUZ[P[\JP}UPUT\UP[HYPH
TH`VYK\YHJP}UKLSHZ\WYLZP}UKLSHYLWSPJHJP}U
]PYHS ,S UHKPY V W\U[V TmZ IHQV HSJHUaHKV LZ (KLTmZ KL JVUVJLY J}TV X\LKH LS LZ[HKV
PTWVY[HU[LWHYHKLÄUPYLSYPLZNVKLYLIV[LKLSH PUT\UVS}NPJVKLLZ[VZWHJPLU[LZWVY[VTHYKL
JHYNH]PYHS`SHWVZPIPSPKHKKLYLZPZ[LUJPHZ WVY]PKHHU[PYYL[YV]PYHSLZLZPTWVY[HU[LLZ[\KPHY
[VKVZLZ[VZL]LU[VZPUT\UVS}NPJVZ`HStYNPJVZKL
DISCUSIÓN SVZKPZ[PU[VZHU[PYYL[YV]PYHSLZL_PZ[LU[LZHZxJVTV
SHYLZW\LZ[HWHY[PJ\SHYKLSVZWHJPLU[LZWVYSV
(WLZHYKLZHILYX\LLSWYVWPV[YH[HTPLU[VJVU X\LLULSSVZLZULJLZHYPVJVU[PU\HYYLHSPaHUKV
HU[PYYL[YV]PYHSLZ WYV]VJH LMLJ[VZ PUKLZLHISLZ LZ[\KPVZ`\UTPU\JPVZVZLN\PTPLU[VJSxUPJV
` [}_PJVZ LU LS M\UJPVUHTPLU[V KL KP]LYZVZ
}YNHUVZ LS TtKPJV [YH[HU[L KL WHJPLU[LZ JVU REFERENCIAS
=0/ LU]xH H SVZ HSLYN}SVNVZ H LZ[VZ WHJPLU[LZ
WHYH ZHILY ZP SHZ SLZPVULZ X\L THUPÄLZ[HU LU 1. Kelze >, Pilloǁ d. PhenLJtoin-induced drug reacƟon ǁith
eosinophilia and sLJstemic sLJmptoms ;DRSSͿ sLJndrome:
SH WPLS WVY LQLTWSV LYP[YVKLYTPH ` L_HU[LTH A case report from the emergency department. J Emerg
TmJ\SVWHW\SHY NLULYHSPaHKV ZVU JH\ZHKHZ Med 2013;44:75-78.
WVY WYVISLTHZ KL [PWV HStYNPJV HS HU[PYYL[YV]P- 2. ,arr d, French >E. Severe cutaneous adverse reacƟons: acu-
ral,WLYVHKLTmZHSN\UVZKLLZ[VZWHJPLU[LZ te generalized exanthematous pustulosis, toxic epidermal
necrolysis and Stevens-Johnson syndrome. Med Clin North
W\LKLUWHKLJLYLSZxUKYVTLKLYLJVUZ[P[\JP}U
Am 2010;94:727-742.
PUT\UVS}NPJHLULSX\LZLOHLUJVU[YHKVX\L
3. Cacoub P, MuseƩe P, Descamps V, Meyer K, et al. dhe DRESS
LU T\JOVZ WHJPLU[LZ ZVIYL [VKV LU Z\QL[VZ syndrome: a literature revieǁ. Am J Med 2011;124:588-
JVU IHQVZ YLJ\LU[YVZ KL JtS\SHZ *+ HU[LZ 597.
KL LTWLaHY LS [YH[HTPLU[V HU[PYYL[YV]PYHS SVZ 4. Chamizo-López FJ, Gilarranz-Luengo R, Hernández-Febles M,
ZxU[VTHZ X\L THUPÄLZ[HU LZ[mU YLSHJPVUHKVZ Pena-López MJ. dransmission of anƟretroviral drug resistant
strains in paƟents diagnosed ǁith human immunodeĮcien-
JVU \UH YLWHYHJP}U KLS ZPZ[LTH PUT\UP[HYPV V cy virus infecƟon in Gran Canaria in the period 2009-2012.
YLJVUZ[P[\JP}UPUT\UVS}NPJHJVTVYLZ\S[HKVKLS Enferm Infecc Microbiol Clin 2014;32:695-696.


Revista Alergia México Volumen 62, Núm. 2, abril-junio 2015

5. Ramiro MA, Llibre JM. Legal, ethical, and economic impli- 10. dorres HA, Rallapalli V, Saxena A, Granǁehr , et al. Eĸcacy
caƟons of breaŬing doǁn once-daily Įxed-dose anƟretro- and safety of anƟretrovirals in HIV-infected paƟents ǁith
viral combinaƟons into their single components for cost cancer. Clin Microbiol Infect 2014. [Epub ahead of print].
reducƟon. Enferm Infecc Microbiol Clin 2014;32:598-602. 11. Rubinstein PG, AboulaĮa DM, Zloza A. Malignancies in HIVͬ
6. Sánchez y, Merlano C, Cruz C. Drug rash ǁith eosinophilia AIDS: From epidemiology to therapeuƟc challenges. AIDS
and systemic symptoms ;DRESSͿ. Rev Asoc Col Dermatol 2014;28:453-465.
2008;16:208-210. 12. Nayadu S<, alar . Colorectal cancer screening in human
7. Fobelo Lozano MJ. AnƟretroviral therapy. DetecƟon of immunodeĮciency virus populaƟon: Are they at average
adverse drug reacƟons from hospital admission diagnoses. risŬ͍ torld J Gastrointest Kncol 2012;15:259-264.
Farmacia Hospitalaria 1999;23:337-342. 13. Vaũdic CM, van Leeuǁen Md. that types of cancers are
8. Moya z, ernal F, Roũas E, arthel E. PharmaceuƟcal folloǁ associated ǁith immune suppression in HIV͍ Lessons
up of anƟrretroviral treatment in outpaƟents. Rev Chil from solid organ transplant recipients. Curr Kpin HIV AIDS
Infectol 2012;29:412-419. 2009;4:35-41.
9. Sharma M, talmsley SL. Raltegravir as anƟretroviral the- 14. talŬty A, Smith D, LopŬo RN, et al. Severe sŬin rash as-
rapy in HIVͬAIDS. Expert Kpin Pharmacother 2014;15:395- sociated ǁith atazanavir. Can J Infect Dis Med Microbiol
405. 2009;20:e10-e12.



Potrebbero piacerti anche