García García M J, Morano Amado L E, Allegue Rodríguez F, Miralles Alvarez C, Ocampo Hermida A
Servicios de Medicina Interna-Infecciosas, Hospital do Meixoeiro, Vigo.
Rev Clin Esp. 2001 Aug;201(8):455-8. doi: 10.1016/s0014-2565(01)70878-8.
A retrospective study of cases of paronychia associated with anti-retroviral therapy diagnosed in two general hospitals is here reported. Lesions appeared from 3 and 48 months after institution of therapy. At diagnosis, 84.6% of patients were on indinavir therapy. CD4 values ranged from 120 and 1,332 cells/mm3 and viral load was lower than 200 copies/ml in 92.3 of cases. Conservative therapy was applied in 7 patients and surgery in 6. In all patients indinavir therapy was discontinued, and cure was achieved 16 weeks later. The "retinoid" effect of indinavir is discussed as likely pathogenic explanation for this complications. We advocate for topic therapy and change of anti-retroviral therapy, reserving surgery for patients not responding to therapy. Pain and functional limitation caused by this non uncommon complication (1.6% of our patients treated with anti-retroviral agents) makes its knowledge necessary and an active search by clinicians in patients receiving indinavir therapy.
本文报告了一项在两家综合医院对与抗逆转录病毒疗法相关的甲沟炎病例的回顾性研究。病变出现在治疗开始后的3至48个月。诊断时，84.6%的患者正在接受茚地那韦治疗。CD4值在120至1332个细胞/mm³之间，92.3%的病例病毒载量低于200拷贝/ml。7例患者采用保守治疗，6例患者采用手术治疗。所有患者均停用茚地那韦治疗，16周后治愈。讨论了茚地那韦的“类视黄醇”效应，认为这可能是该并发症的致病原因。我们主张采用局部治疗并更换抗逆转录病毒疗法，对于治疗无反应的患者则保留手术治疗。这种并不罕见的并发症（在我们接受抗逆转录病毒药物治疗的患者中占1.6%）所引起的疼痛和功能受限，使得了解该并发症并让临床医生对接受茚地那韦治疗的患者进行积极排查变得必要。
