Search

(b) Microscopic image of a needle-shaped crystal, consistent with a leukocyte acyclovir crystal, in the urine. gl Urine acyclovir crystallization is a complication of high-dose acyclovir infusion5 as well as of high-dose valacyclovir administration. Recently, the use of high-dose oral valacyclovir (an acyclovir prodrug) to prevent vertical transmission of CMV after maternal primary infection during the first trimester has been shown to be beneficial, with a 71% reduction in the congenital infection rate3. Cytomegalovirus (CMV) is the most common cause of congenital infection, affecting about 0.6% of all live births worldwide1. [Extracted from the article]

Vemurafenib, a selective BRAF (v-raf murine sarcoma viral oncogene homologue B1) kinase inhibitor, is a new targeted biotherapy that improves survival in patients with metastatic melanomas harbouring the BRAF V600E mutation. However, this drug has significant dermatological adverse effects. We report a new severe cutaneous reaction to this drug associated with acute kidney injury ( AKI). Four patients presented a generalized grade 3 ( Common Terminology Criteria for Adverse Events) erythematous eruption with hyperkeratosis pilaris, 5-14 days after the introduction of vemurafenib. These symptoms were associated with AKI in all cases and transitory hypereosinophilia in two cases. Vemurafenib treatment was stopped in three patients and the dose was reduced in the fourth, leading to a gradual improvement of skin symptoms and renal function. Positron-emission tomography scans showed a complete response in three cases and a major response in one case. Vemurafenib was reintroduced at a lower dose, without a relapse of the rash, but renal function again deteriorated. Thus, we report a cluster of four cases of AKI associated with similar, severe, grade 3 cutaneous drug reactions related to vemurafenib. [ABSTRACT FROM AUTHOR]