Intravenous Ribavirin and Hyperammonemia
Intravenous Ribavirin and Hyperammonemia
Ribavirin is a synthetic guanosine analog with activity against DNA and RNA viruses. It was studied in human trials, and no marked adverse effect was reported beyond the potential for teratogenicity and reversible mild anemia. An 8-year-old girl received a multivisceral transplant and developed adenoviral pneumonia. She was treated with intravenous ribavirin and became hyperammonemic. Discontinuation of ribavirin led to a decrease in ammonia levels. This pattern was repeated when the drug was restarted and discontinued. We hypothesize that in a toxic environment the interaction of ribavirin with hepatocellular mitochondrial enzymes may lead to hyperammonemia.
Ribavirin is a synthetic nucleoside analog with a broad spectrum of inhibitory activity against both DNA and RNA viruses. Specifically, it has in vitro activity against respiratory syncytial virus (RSV), influenzae A and B viruses, herpes simplex virus, and human immunodeficiency virus. It is commonly administered in aerosolized form in selected infants with severe RSV pneumonia. Case reports suggest that intravenous ribavirin may be effective in treating Lassa fever and hemorrhagic fever with renal syndrome.
Adenovirus is composed of double-stranded DNA and is common in children, accounting for 5-8% of pediatric respiratory infections. It routinely results in a self-limited illness in a healthy host. It is characterized classically by pharyngitis, conjunctivitis, tracheobronchitis, and fever. In an immunosuppressed patient, infection with adenovirus may be life threatening. No known effective antiviral therapy is available, although one case report in the literature described successful treatment with cidofovir, a cytidine analog, in a stem cell transplant recipient.
There are individual case reports of immunocompromised patients with adenoviral gastroenteritis, hemorrhagic cystitis, and pneumonia successfully treated with intravenous ribavirin. The only serious toxic effect, outside of the known teratogenic risk, in some patients was hemolytic anemia.
We present the case of an 8-year-old girl who received a multivisceral transplant and became infected with adenovirus. She was treated with intravenous ribavirin but developed hyperammonemia. This previously undescribed adverse effect appeared to be temporally associated with ribavirin.
Ribavirin is a synthetic guanosine analog with activity against DNA and RNA viruses. It was studied in human trials, and no marked adverse effect was reported beyond the potential for teratogenicity and reversible mild anemia. An 8-year-old girl received a multivisceral transplant and developed adenoviral pneumonia. She was treated with intravenous ribavirin and became hyperammonemic. Discontinuation of ribavirin led to a decrease in ammonia levels. This pattern was repeated when the drug was restarted and discontinued. We hypothesize that in a toxic environment the interaction of ribavirin with hepatocellular mitochondrial enzymes may lead to hyperammonemia.
Ribavirin is a synthetic nucleoside analog with a broad spectrum of inhibitory activity against both DNA and RNA viruses. Specifically, it has in vitro activity against respiratory syncytial virus (RSV), influenzae A and B viruses, herpes simplex virus, and human immunodeficiency virus. It is commonly administered in aerosolized form in selected infants with severe RSV pneumonia. Case reports suggest that intravenous ribavirin may be effective in treating Lassa fever and hemorrhagic fever with renal syndrome.
Adenovirus is composed of double-stranded DNA and is common in children, accounting for 5-8% of pediatric respiratory infections. It routinely results in a self-limited illness in a healthy host. It is characterized classically by pharyngitis, conjunctivitis, tracheobronchitis, and fever. In an immunosuppressed patient, infection with adenovirus may be life threatening. No known effective antiviral therapy is available, although one case report in the literature described successful treatment with cidofovir, a cytidine analog, in a stem cell transplant recipient.
There are individual case reports of immunocompromised patients with adenoviral gastroenteritis, hemorrhagic cystitis, and pneumonia successfully treated with intravenous ribavirin. The only serious toxic effect, outside of the known teratogenic risk, in some patients was hemolytic anemia.
We present the case of an 8-year-old girl who received a multivisceral transplant and became infected with adenovirus. She was treated with intravenous ribavirin but developed hyperammonemia. This previously undescribed adverse effect appeared to be temporally associated with ribavirin.