Dolor talámico secundario a una toxoplasmosis cerebral en un paciente con SIDA.

Introduction: Pain in HIV/AIDS patients may have diverse mechanisms. Nearly half of the pain is neuropathic, reflecting injury from viral infection, opportunistic agents, or neurotoxic effects of antiretroviral therapy. Patient treatment is complex, particularly in the setting of antiretroviral therapy. We report the case of an AIDS patient with thalamic pain, followed in a chronic pain unit for 12 years. Case report: A 55-year-old male with AIDS and cerebral toxoplasmosis, sent to the chronic pain unit with thalamic pain (2002). He complained of severe pain (VAS 8) in the right hemibody with numbness, electric discharge, and altered thermal sensibility. Initial prescription was: gabapentin 1,600 mg/day, amitriptyline 50 mg/d paracetamol 1 g tid y AINEs en SOS. to cerebral toxoplasmosis]/AIDS patientay, and tramadol 100 mg twice daily. One year later, pain worsening lead to dose increase. In March 2007 we added baclofen to the prescription. Months later, due to renal lesion, it was necessary to change the therapeutic scheme. In 2012 we add clonazepam and mirtazapine. Pain control allowed dose reductions. The patient died in 2014. Discussion: Chronic pain in HIV-infected patients can be severe and disabling. Treatment is difficult as multiple mechanisms are involved. Antiretroviral therapy poses the risk of pharmacological interactions and drug toxicity. We emphasize ritonavir inhibition of CYP3A4 and CYP2D6, increasing plasmatic concentrations and toxicity of drugs metabolized by the same way. [ABSTRACT FROM AUTHOR]