Paronychia with pyrogenic granuloma in a child treated with indinavir: Theretinoid-mediated side effect theory revisited

Background: The introduction of HIV-1 protease inhibitors into the treatmen t of patients infected with HIV-1 has had a major influence on clinical pra ctice. However, the use of protease inhibitors is frequently associated wit h the development of resistance and several side effects and interactions w ith other drugs have been reported. Observations: We present the first pedi atric patient with paronychia with pyogenic granuloma associated with the a dministration of the protease inhibitor indinavir. Clinical findings are di scussed in view of a possible interference of indinavir with endogenous ret inoid metabolism. Conclusion: Considerable evidence advocates the mediation of indinavir side effects by impaired oxidative metabolism of retinoic aci d through the inhibition of cytochromes P450 3A by indinavir rather than by impaired formation of 9-cis-retinoic acid. Copyright (R) 2000 S. Karger AG . Basel.