Emtricitabine-induced pure red cell aplasia

Nithendra Manickchund; Camille du Plessis; Melanie-Anne A John; Thandekile C Manzini; Bernadett I Gosnell; Richard J Lessells; Yunus S Moosa

doi:10.4102/sajhivmed.v20i1.983

Emtricitabine-induced pure red cell aplasia

South Afr J HIV Med. 2019 Sep 23;20(1):983. doi: 10.4102/sajhivmed.v20i1.983. eCollection 2019.

Authors

Nithendra Manickchund^{1

2}, Camille du Plessis^{1

2}, Melanie-Anne A John², Thandekile C Manzini², Bernadett I Gosnell^{1

2}, Richard J Lessells^{2

3

4}, Yunus S Moosa^{1

2}

Affiliations

¹ King Edward VIII Hospital, Durban, South Africa.
² Department of Infectious Diseases, University of KwaZulu-Natal, Durban, South Africa.
³ KwaZulu-Natal Research and Innovation Sequencing Platform (KRISP), University of KwaZulu-Natal, Durban, South Africa.
⁴ Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa.

Abstract

Introduction: Anemia is common in HIV. Parvo B19 infection is a well-recognised cause of red cell aplasia. Other causes of persistent pure red cell aplasia (PRCA) include anti-retroviral drugs such as zidovudine and lamivudine. We describe a case of PRCA that strongly implicates emtricitabine as the probable cause.

Patient presentation: Patient was HIV positive and on treatment with a fixed drug combination consisting of tenofovir, emtricitabine and efavirenz for 3 months when she developed severe transfusion dependent anemia. The anemia, attributed to PRCA, was persistent and transfusion dependent for about one year.

Management and outcome: Replacement of emtricitabine with abacavir resulted in a prompt, complete and lasting resolution of the anaemia, suggesting an etiologic role of emtricitabine in the PRCA.

Conclusion: Emtricitibine is a rare cause of pure red cell aplasia.

Keywords: adverse drug reaction; antiretroviral; drug induced; emtricitabine; pure red cell aplasia; rare drug toxicity.

Publication types

Case Reports