Efavirenz-induced urolithiasis

Article Article scientifique Rapport de cas Efavirenz-induced urolithiasis eng 2006 author Wirth Grégory Johann 563918 author Teuscher Juerg 51601 author Graf Jean-Daniel 526519 author Iselin Christophe 29699 288-289 10.1007/s00240-006-0052-6 16625385 0300-5623 We describe the first case of efavirenz-induced urolithiasis in a 47-year-old HIV-positive patient. Urinary obstruction led to pyelonephritis and septic shock, requiring emergency ureteral catheterisation. The subsequent clinical course was favourable, allowing the patient's discharge on day 5. A 7 mm, radio-translucent, non-crystalline, beige stone was extracted during catheterisation. Stone analysis by Fourier transform infrared spectrometry, liquid chromatography and mass spectrometry revealed a stone composed of efavirenz (EFV) metabolites M4, M5, M8 (as described by Mutlib et al. in 1999) and approximately 50% of unspecified proteins. EFV is a non-nucleoside reverse transcriptase inhibitor introduced to European markets in 1999. It is principally metabolised by cytochrome P450 3A4 and 2B6. Of the dose, 14-34% is excreted in the urine, 1% as unchanged drug. The patient had been taking 600 mg EFV per day for 3 years. As EFV-induced urolithiasis has not been reported so far, we would like to draw the attention of the medical community to this potentially severe complication. Anti-HIV Agents/adverse effects/metabolism Benzoxazines Humans Male Middle Aged Oxazines/adverse effects/metabolism Pyelonephritis/etiology Urinary Calculi/chemically induced/chemistry/complications Dewey 617 Open Access - Licence nationale Springer 57 Département de chirurgie 222 false 81 Groupe Iselin Christophe (urologie) 106 Urological research 34 4 9b38ace1-cbee-4e22-91f6-1588b86f6b8e Article (Published version) Public art%253A10.1007%252Fs00240-006-0052-6.pdf 234125 application/pdf openAccess Faculté de médecine / Section de médecine clinique / Département de chirurgie

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Efavirenz-induced urolithiasis	Urological research			2006	571	308

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Teuscher, Juerg