We report a case in which an HIV-positive man developed general malaise, skin rash and biochemical hepatitis within days of starting a nevirapine-based antiretroviral treatment regimen. At the same time, his syphilis serology proved positive. We discuss the diagnostic dilemma: was this a nevirapine hypersensitivity reaction, secondary syphilis or both?
MontanerJSReissPCooperD. A randomized, double-blind trial comparing combinations of nevirapine, didanosine, and zidovudine for HIV-infected patients: the INCAS Trial. Italy, The Netherlands, Canada and Australia Study. JAMA1998; 279: 930–937.
CattelanAMErneESalatinoA. Severe hepatic failure related to nevirapine treatment. Clin Infect Dis1999; 29: 455–456.
4.
MulloolyCHigginsSP. Secondary syphilis: the classical triad of skin rash, mucosal ulceration and lymphadenopathy. Int J STD AIDS2010; 21: 537–545.
5.
MullickCJLiappisAPBenatorDA. Syphilitic hepatitis in HIV-infected patients: a report of 7 cases and review of the literature. Clin Infect Dis2004; 39: e100–e105.
6.
LikanonsakulSRattanathamTFeangvadS. HLA-Cw*04 allele associated with nevirapine-induced rash in HIV-infected Thai patients. AIDS Res Ther2009; 6: 22–22.
7.
YuanJGuoSHallD. Toxicogenomics of nevirapine-associated cutaneous and hepatic adverse events among populations of African, Asian, and European descent. AIDS2001; 25: 1271–1280.
8.
MartinAMNolanDJamesI. Predisposition to nevirapine hypersensitivity associated with HLA-DRB1m0101 and abrogated by low CD4 T-cell counts. AIDS2005; 19: 97–98.
9.
VitezicaZGMilpiedBLonjouC. HLA-DRB1*01 associated with cutaneous hypersensitivity induced by nevirapine and efavirenz. AIDS2008; 22: 540–541.
10.
BourezaneYSalardDHoenB. DRESS (Drug rash with eosinophilia and systemic symptoms) syndrome associated with nevirapine therapy. Clin Infect Dis1998; 27: 1321–1322.
11.
OlserW. Familiar medical quotations, 1st ed. Boston, MA: Little, Brown and Co, 1968, pp. 651–651.
