Efavirenz-induced gynecomastia in a prepubertal girl with human immunodeficiency virus infection: a case report

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dc.contributor.authorvan Ramshorst, Metteen_ZA
dc.contributor.authorKekana, Magdelineen_ZA
dc.contributor.authorStruthers, Helenen_ZA
dc.contributor.authorMcIntyre, Jamesen_ZA
dc.contributor.authorPeters, Remcoen_ZA
dc.date.accessioned2015-11-27T09:33:31Z
dc.date.available2015-11-27T09:33:31Z
dc.date.issued2013en_ZA
dc.description.abstractBACKGROUND:Prepubertal gynecomastia is a rare condition and most frequently classified as idiopathic. In HIV-infected adults gynecomastia is a recognised but infrequent side-effect of antiretroviral treatment (ART) and mostly attributed to efavirenz use. Gynecomastia should be distinguished from pseudogynecomastia as part of the lipodystrophy syndrome caused by Nucleoside Reverse Transcriptase Inhibitors (NRTIs) to avoid incorrect substitution of drugs. In the medical literature only five cases of prepubertal gynecomastia in children taking ART are described and underlying pathogenesis was unknown. The occurrence of adverse effects of ART may interfere with therapy adherence and long-term prognosis and for that reason requires attention. We report the first case of prepubertal gynecomastia in a young girl attributed to efavirenz use.CASE PRESENTATION:A seven-year-old African girl presented with true gynecomastia four months after initiation on ART (abacavir, lamivudine, efavirenz). History, physical examination and laboratory tests excluded known causes of gynecomastia and efavirenz was considered as the most likely cause. Six weeks after withdrawal of efavirenz the breast enlargement had completely resolved. CONCLUSIONS: Efavirenz-induced gynecomastia may occur in children as well as in adults. With the increasing access to ART, the possibility of efavirenz-exposure and the potential occurrence of its associated side-effects may be high. In resource-poor settings, empirical change from efavirenz to nevirapine may be considered, providing no other known or alarming cause is identified, as efavirenz-induced gynecomastia can resolve quickly after withdrawal of the drug. Timely recognition of gynecomastia as a side-effect of efavirenz is important in order to intervene while the condition may still be reversible, to sustain adherence to ART and to maintain the sociopsychological health of the child.en_ZA
dc.identifier.apacitationvan Ramshorst, M., Kekana, M., Struthers, H., McIntyre, J., & Peters, R. (2013). Efavirenz-induced gynecomastia in a prepubertal girl with human immunodeficiency virus infection: a case report. <i>BMC Pediatrics</i>, http://hdl.handle.net/11427/15394en_ZA
dc.identifier.chicagocitationvan Ramshorst, Mette, Magdeline Kekana, Helen Struthers, James McIntyre, and Remco Peters "Efavirenz-induced gynecomastia in a prepubertal girl with human immunodeficiency virus infection: a case report." <i>BMC Pediatrics</i> (2013) http://hdl.handle.net/11427/15394en_ZA
dc.identifier.citationvan Ramshorst, M. S., Kekana, M., Struthers, H. E., McIntyre, J. A., & Peters, R. P. (2013). Efavirenz-induced gynecomastia in a prepubertal girl with human immunodeficiency virus infection: a case report. BMC pediatrics, 13(1), 120.en_ZA
dc.identifier.ris TY - Journal Article AU - van Ramshorst, Mette AU - Kekana, Magdeline AU - Struthers, Helen AU - McIntyre, James AU - Peters, Remco AB - BACKGROUND:Prepubertal gynecomastia is a rare condition and most frequently classified as idiopathic. In HIV-infected adults gynecomastia is a recognised but infrequent side-effect of antiretroviral treatment (ART) and mostly attributed to efavirenz use. Gynecomastia should be distinguished from pseudogynecomastia as part of the lipodystrophy syndrome caused by Nucleoside Reverse Transcriptase Inhibitors (NRTIs) to avoid incorrect substitution of drugs. In the medical literature only five cases of prepubertal gynecomastia in children taking ART are described and underlying pathogenesis was unknown. The occurrence of adverse effects of ART may interfere with therapy adherence and long-term prognosis and for that reason requires attention. We report the first case of prepubertal gynecomastia in a young girl attributed to efavirenz use.CASE PRESENTATION:A seven-year-old African girl presented with true gynecomastia four months after initiation on ART (abacavir, lamivudine, efavirenz). History, physical examination and laboratory tests excluded known causes of gynecomastia and efavirenz was considered as the most likely cause. Six weeks after withdrawal of efavirenz the breast enlargement had completely resolved. CONCLUSIONS: Efavirenz-induced gynecomastia may occur in children as well as in adults. With the increasing access to ART, the possibility of efavirenz-exposure and the potential occurrence of its associated side-effects may be high. In resource-poor settings, empirical change from efavirenz to nevirapine may be considered, providing no other known or alarming cause is identified, as efavirenz-induced gynecomastia can resolve quickly after withdrawal of the drug. Timely recognition of gynecomastia as a side-effect of efavirenz is important in order to intervene while the condition may still be reversible, to sustain adherence to ART and to maintain the sociopsychological health of the child. DA - 2013 DB - OpenUCT DO - 10.1186/1471-2431-13-120 DP - University of Cape Town J1 - BMC Pediatrics LK - https://open.uct.ac.za PB - University of Cape Town PY - 2013 T1 - Efavirenz-induced gynecomastia in a prepubertal girl with human immunodeficiency virus infection: a case report TI - Efavirenz-induced gynecomastia in a prepubertal girl with human immunodeficiency virus infection: a case report UR - http://hdl.handle.net/11427/15394 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/15394
dc.identifier.urihttp://dx.doi.org/10.1186/1471-2431-13-120
dc.identifier.vancouvercitationvan Ramshorst M, Kekana M, Struthers H, McIntyre J, Peters R. Efavirenz-induced gynecomastia in a prepubertal girl with human immunodeficiency virus infection: a case report. BMC Pediatrics. 2013; http://hdl.handle.net/11427/15394.en_ZA
dc.language.isoengen_ZA
dc.publisherBioMed Central Ltden_ZA
dc.publisher.departmentDepartment of Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an Open Access article distributed under the terms of the Creative Commons Attribution Licenseen_ZA
dc.rights.holdervan Ramshorst et al.; licensee BioMed Central Ltd.en_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/2.0en_ZA
dc.sourceBMC Pediatricsen_ZA
dc.source.urihttp://www.biomedcentral.com/bmcpediatr/en_ZA
dc.subject.otherGynecomastiaen_ZA
dc.subject.otherHIVen_ZA
dc.subject.otherEfavirenzen_ZA
dc.subject.otherChilden_ZA
dc.subject.otherPrepubertalen_ZA
dc.titleEfavirenz-induced gynecomastia in a prepubertal girl with human immunodeficiency virus infection: a case reporten_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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