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Ann Thorac Surg 2002;74:1251-1252
© 2002 The Society of Thoracic Surgeons

Case report

Type B lactic acidosis: a rare complication of antiretroviral therapy after cardiac surgery

Bernard G. Vasseur, MD*a, Hideki Kawanishi, MDb, Nahir Shah, MDc, Mark L. Anderson, MDa

a Department of Surgery and Medicine, University of Medicine, New Brunswick, New Jersey, USA
b Dentistry of New Jersey—Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
c Department of Cardiology, Saint Peters University Hospital, New Brunswick, New Jersey, USA

Accepted for publication June 10, 2002.

* Address reprint requests to Dr Vasseur, Division of Thoracic Surgery, University of Medicine and Dentistry of New Jersey—Robert Wood Johnson Medical School, PO Box 19, New Brunswick, NJ 08903-0019 USA
e-mail: vasseubg{at}umdnj.edu

This report describes a 47-year-old woman with human immunodeficiency virus (HIV) and end-stage renal disease on hemodialysis, treated with combination antiretroviral drug therapy, who developed an acute, severe type B lactic acidosis 24 hours after homograft root replacement for endocarditis. She fully recovered after HIV medication was discontinued, along with administration of riboflavin and supportive measures including hemodialysis. The timing of this complication and previous reports suggest that open heart surgery may be a risk factor for nonischemic (type B) lactic acidosis in patients taking nucleoside analogue reverse transcriptase inhibitors.






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