Hyperlactataemia and hepatic steatosis: mitochondrial toxicity of nucleoside reverse transcriptase inhibitors.

A 40 year old heterosexual black African man presented to the accident and emergency department with a 4 minute episode of loss of consciousness with associated incontinence. On inquiry, he gave a 1 month's history of left sided headache, weight loss, fever, and a right axillary swelling. He had a medical history of recurrent malaria, typhoid as a child, drainage of groin abscess in 1999, and severe acne. An HIV antibody test had been negative in 1993. On admission he was taking ciprofloxacin 500 mg twice daily, prescribed by a primary care physician as treatment for the axillary infection; he had recently completed a course of isotretinoin as treatment for acne. He worked as a delivery driver, drank no alcohol, and was a non-smoker. He had been resident in Great Britain for 7 years. On examination he was pyrexial, temperature 38.5°C, had oral candida, severe acne, and a 4 cm diameter infected sebaceous cyst in the right axilla.