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VIRTUAL MEDZONE

This case presentation by Stephen Shafran, MD, Anne Marie Zajdlik, MD, and David Fletcher, MD, explores the intriguing medical history of a 45-year-old man living with HIV since 1998. Despite having a robust viral load suppression and stable CD4 counts on a complex regimen, the patient unexpectedly presented with severe bilateral leg pain and erythema. The investigation revealed that prior medication for a migraine led to ergotism and vascular insufficiency due to spasm. This emphasizes the importance of medication history in patient management and highlights innovative communication in HIV care.

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VIRTUAL MEDZONE

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  1. VIRTUAL MEDZONE Your Resource for HIV Related Innovative Medical Communication

  2. HIV CASE PRESENTATIONS Stephen Shafran MD FRCPC Anne Marie Zajdlik MD CCFP David Fletcher MD FRCPC

  3. CASE 1 • 45 yo man • HIV+ 1998 • CD4 nadir <10 • Multiple antiretroviral regimens over 15 yrs

  4. CASE 1 Current regimen: • ABC/3TC/RTV/DRV/ETV/RGV/ Rosuvastatin/Nadolol • CD4 220 • VL<50 x 8 months

  5. CASE 1 March 2011 • Awakens one morning with significant bilateral leg pain/erythema lasting 3 days • No fevers/blistering or migration of erythema

  6. CASE 1 March 2011 • Described as burning/cramping muscle pain +/- bone pain…not skin/joint pain • No joint/leg swelling

  7. CASE 1 March 2011 • Pain completely gone at clinic visit • Noted during pain that feet were cold and pulses were barely palpable • ASA 325 mg prn relieved pain within minutes throughout the day

  8. CASE 1 March 2011…In the office • Examination unremarkable from a neurological, vascular, MSK, and dermatological standpoint Cause???

  9. CASE 1 On further detailed history: • He had a migraine H/A the evening before and took an OTC migraine pill (in Costa Rica) • Ergotamine/caffeine/Dipirone

  10. CASE 1 ERGOTISM!!! • Vascular insufficiency due to spasm • Role of RTV/DRV and Nadolol • Role of ETV

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